Foster Jason M, Zhang Chunmeng, Rehman Shahyan, Sharma Prateek, Alexander H Richard
Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey.
CA Cancer J Clin. 2023 Jan;73(1):49-71. doi: 10.3322/caac.21749. Epub 2022 Aug 15.
Peritoneal metastasis (PM) is often regarded as a less frequent pattern of spread; however, collectively across all spectra of primary tumors, the consequences of PM impact a large population of patients annually. Unlike other modes of metastasis, symptoms at presentation or during the treatment course are common, representing an additional challenge in the management of PM. Early efforts with chemotherapy and incomplete surgical interventions transiently improved symptoms, but durable symptom control and survival extension were rare, which established a perspective of treatment futility for PM through most of the 20th century. Notably, the continued development of better systemic therapy combinations, optimization of cytoreductive surgery (CRS), and rigorous investigation of combining regional therapy-specifically hyperthermic intraperitoneal chemotherapy-with CRS, have resulted in more effective multimodal treatment options for patients with PM. In this article, the authors provide a comprehensive review of the data establishing the contemporary approach for tumors with a high frequency of PM, including appendix, colorectal, mesothelioma, and gastric cancers. The authors also explore the emerging role of adding hyperthermic intraperitoneal chemotherapy to the well established paradigm of CRS and systemic therapy for advanced ovarian cancer, as well as the recent clinical trials identifying the efficacy of poly(adenosine diphosphate ribose) polymerase maintenance therapy. Finally, recent data are included that explore the role of precision medicine technology in PM management that, in the future, may help further improve patient selection, identify the best systemic therapy regimens, detect actionable mutations, and identify new targets for drug development.
腹膜转移（PM）通常被认为是一种不太常见的扩散模式；然而，在所有原发性肿瘤类型中，PM每年影响大量患者。与其他转移方式不同，PM在就诊时或治疗过程中出现症状很常见，这给PM的管理带来了额外挑战。早期化疗和不完全手术干预曾短暂改善症状，但持久的症状控制和生存期延长很少见，这使得在20世纪的大部分时间里，人们对PM的治疗前景持悲观态度。值得注意的是，更好的全身治疗组合的持续发展、细胞减灭术（CRS）的优化以及对区域治疗（特别是腹腔内热灌注化疗）与CRS联合应用的深入研究，为PM患者带来了更有效的多模式治疗选择。在本文中，作者全面回顾了确立当代针对PM高发肿瘤（包括阑尾癌、结直肠癌、间皮瘤和胃癌）治疗方法的数据。作者还探讨了在晚期卵巢癌已确立的CRS和全身治疗模式中加入腹腔内热灌注化疗的新作用，以及近期确定聚（腺苷二磷酸核糖）聚合酶维持治疗疗效的临床试验。最后，纳入了近期数据，这些数据探讨了精准医学技术在PM管理中的作用，未来可能有助于进一步优化患者选择、确定最佳全身治疗方案、检测可操作的突变以及识别药物研发的新靶点。
