Center for Colon and Rectal Cancer, Surgical Health Outcomes Consortium, AdventHealth Orlando, Orlando, Florida.
Kansas City University of Medicine and Biosciences, Kansas City, Missouri.
Dis Colon Rectum. 2022 Jan 1;65(1):16-26. doi: 10.1097/DCR.0000000000002315.
Combined treatment modality of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is emerging as an alternative option for colorectal peritoneal metastases, but there is ambiguity regarding patient selection, treatment protocols, and efficacy.
To elaborate on the patient characteristics, hyperthermic intraperitoneal chemotherapy protocol and health outcomes in colorectal peritoneal metastases patients undergoing a combination of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery and provide guidance for future studies.
A Medline search for English language studies published between 2004 and 2019.
Medical subject headings and key terms, including: hyperthermic intraperitoneal chemotherapy, colorectal peritoneal metastases, colorectal cancer and combinations thereof as per guidelines.
Overall survival, disease-free survival, and morbidity and mortality rates.
Of the 26 included studies, 42% were published between 2016 and 2019. More than half of the studies were retrospective in nature and conducted in tertiary specialized centers outside of the United States. The median age range was 44 to 62 years. Mitomycin C-based therapy was seen in 50% of studies. Mean weighted median disease-free survival for 11 studies was 15 months (9 to 36 months). Median OS ranged from 12 to 63 months, with an average of 33.6 months among 20 studies. Overall morbidity varied from 11% to 56%, with a weighted mean of 29% in 18 studies. Mortality ranged from 0 to 34%, with a weighted mean of 4% in 15 studies.
Despite careful study selection, variability in methodology of the included studies can limit review findings.
Due to study heterogeneity, and a recent large, randomized trial showing no overall benefit, use of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in colorectal peritoneal metastases patients is highly controversial. Further standardized controlled studies can help uniformly define and build consensus among the medical community on patient eligibility and the optimal hyperthermic intraperitoneal chemotherapy techniques.
Registered on March 3, 2020, CRD42020146942.
细胞减灭术联合腹腔热灌注化疗作为结直肠腹膜转移的一种替代治疗方法正在兴起，但在患者选择、治疗方案和疗效方面仍存在不确定性。
阐述结直肠腹膜转移患者行细胞减灭术联合腹腔热灌注化疗的患者特征、腹腔热灌注化疗方案和健康结局，并为未来的研究提供指导。
对 2004 年至 2019 年间发表的英文文献进行了 Medline 检索。
根据指南，使用医学主题词和关键词，包括：腹腔热灌注化疗、结直肠腹膜转移、结直肠癌及其组合。
总生存率、无病生存率以及发病率和死亡率。
在纳入的 26 项研究中，42%的研究发表于 2016 年至 2019 年。超过一半的研究为回顾性研究，且在美国以外的三级专业中心进行。中位年龄范围为 44 至 62 岁。在 50%的研究中使用了丝裂霉素 C 为基础的治疗。11 项研究的平均加权中位无病生存率为 15 个月（9 至 36 个月）。20 项研究中中位 OS 范围为 12 至 63 个月，平均为 33.6 个月。总发病率从 11%到 56%不等，18 项研究的加权平均发病率为 29%。死亡率从 0 到 34%不等，15 项研究的加权平均死亡率为 4%。
尽管进行了仔细的研究选择，但纳入研究的方法学差异可能会限制综述结果。
由于研究的异质性以及最近一项大型随机试验显示无总体获益，细胞减灭术联合腹腔热灌注化疗在结直肠腹膜转移患者中的应用仍存在很大争议。进一步的标准化对照研究有助于在医学界内统一定义并就患者资格和最佳腹腔热灌注化疗技术达成共识。
于 2020 年 3 月 3 日注册，CRD42020146942。
