Franko Jan
Chair of Surgical Oncology, Mercy Medical Center, 411 Laurel Street, Suite 2100, Des Moines, IA 50314, USA.
Pleura Peritoneum. 2018 Mar 16;3(1):20180102. doi: 10.1515/pp-2018-0102. eCollection 2018 Mar 1.
Treatment choices for colorectal peritoneal carcinomatosis/metastases include systemic therapy and increasingly cytoreductive surgery with intraperitoneal chemotherapy delivery. These options are best considered as complementary and not exclusive alternatives. Two prospective randomized trials support use of peritonectomy procedures and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. This overview examines efficacy, limitations and landscape of systemic therapy focusing on colorectal peritoneal carcinomatosis. Observations from literature support notions that (1) systemic therapy provides survival benefit for all prototypical patients with mCRC irrespective of metastatic disease site; (2) the magnitude of this benefit is considerably reduced among patients with peritoneal metastases who consequently experience significantly shorter overall survival; (3) efficacy of systemic therapy improved over time but at a slower pace for those with carcinomatosis; (4) this therapeutic difference has not diminished with introduction of targeted therapy, but perhaps widened; (5) further research of cytoreductive surgery and/or intraperitoneal regional therapies is thus a multidisciplinary responsibility of the entire oncology community; (6) peritonectomy procedures with intraperitoneal regional therapy are not scientifically supported in absence of systemic therapies.
结直肠腹膜癌病/转移的治疗选择包括全身治疗，以及越来越多的减瘤手术联合腹腔内化疗。这些选择最好被视为互补而非相互排斥的替代方案。两项前瞻性随机试验支持对结直肠腹膜癌病采用腹膜切除术和腹腔内化疗。本综述探讨了针对结直肠腹膜癌病的全身治疗的疗效、局限性及现状。文献观察结果支持以下观点：（1）全身治疗为所有典型的转移性结直肠癌患者带来生存益处，无论转移病灶位于何处；（2）在有腹膜转移的患者中，这种益处的程度大幅降低，因此这些患者的总生存期显著缩短；（3）全身治疗的疗效随时间有所改善，但对于患有癌病的患者，改善速度较慢；（4）这种治疗差异并未因靶向治疗的引入而缩小，反而可能扩大；（5）因此，对减瘤手术和/或腹腔内区域治疗的进一步研究是整个肿瘤学界的多学科责任；（6）在没有全身治疗的情况下，腹膜切除术联合腹腔内区域治疗缺乏科学依据。
