Royal Prince Alfred Hospital, Sydney, Australia.
Chris O'Brien Lifehouse, Sydney, Australia.
Asia Pac J Clin Oncol. 2022 Feb;18(1):7-12. doi: 10.1111/ajco.13552. Epub 2021 Feb 19.
Colorectal cancer remains the third most common malignancy in Australia with the peritoneum being the second most common metastatic site. Colorectal peritoneal carcinomatosis (CPC) can be treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy but this is only limited to a small subset of patients. Those with inoperable disease have a particularly poor prognosis. While the ideal systemic regimen has not been defined, 5-fluorouracil-based chemotherapy regimens appear to provide overall and progression free survival benefits. The role of targeted agents such as bevacizumab (vascular endothelial growth factor inhibitor) or cetuximab (epidermal growth factor inhibitor) in the setting of CPC is still evolving. Currently, retrospective analyses have shown promising results for the use of bevacizumab in addition to systemic chemotherapy but similar results have not been seen with cetuximab or panitumumab. However, there is significant heterogeneity in the trial data, lack of prospective randomized controlled trials and demonstrated treatment variability based on age and tumour characteristics. This review summarises the current literature in regard to treatment in the unresectable CPC setting as well as discussing issues with the current data and highlighting the need for further trials.
结直肠癌仍然是澳大利亚第三大常见恶性肿瘤，腹膜是第二常见的转移部位。结直肠腹膜癌（CPC）可以通过细胞减灭术和腹腔热化疗来治疗，但这只限于一小部分患者。那些无法手术的患者预后尤其差。虽然尚未确定理想的全身治疗方案，但基于氟尿嘧啶的化疗方案似乎提供了总生存和无进展生存获益。贝伐珠单抗（血管内皮生长因子抑制剂）或西妥昔单抗（表皮生长因子抑制剂）等靶向药物在 CPC 中的作用仍在不断发展。目前，回顾性分析显示贝伐珠单抗联合全身化疗有良好的效果，但西妥昔单抗或帕尼单抗没有类似的效果。然而，试验数据存在显著异质性，缺乏前瞻性随机对照试验，并且根据年龄和肿瘤特征显示出治疗的可变性。这篇综述总结了目前在不可切除 CPC 治疗方面的文献，讨论了当前数据的问题，并强调了进一步试验的必要性。
