Patel Swapnil, Sheshadri Ramakrishnan Ayloor, Saklani Avanish, Sp Somashekhar, Kumar Rohit, Singh Shivendra, Sukumar Vivek, Bhatt Aditi
Department of Surgical Oncology, Upkar Hospital and Cancer Institute, Varanasi, India.
Department of Surgical Oncology, Cancer Institute WIA, Adyar, Chennai, India.
JCO Glob Oncol. 2024 Dec;10:e2400306. doi: 10.1200/GO-24-00306. Epub 2024 Dec 5.
This manuscript reports the results of the Indian Network for Development of Peritoneal Surface Oncology and Indian Society of Peritoneal Surface Malignancies (INDEPSO-ISPSM) consensus that aimed to provide recommendations for some important aspects management of patients with colorectal peritoneal metastases (CPM) and address some issues unique to India.
The modified Delphi technique was used with two rounds of voting. There were 29 questions on nine main topics-the role of cytoreductive surgery (CRS), patient selection for CRS, preoperative workup, role of systemic chemotherapy (SC), CPM with other visceral metastases, molecular profile, hyperthermic intraperitoneal chemotherapy (HIPEC) and other modalities of intraperitoneal chemotherapy (IPC), prophylactic/preventive strategies, and surveillances after CRS. A consensus was achieved if anyone option received >70 votes (strong consensus >90%).
Forty-eight surgical (n = 41) and gastrointestinal (n = 7) oncologists were invited; 44 agreed to participate. The response rate was 95.4% (42/44) in round 1 and 93.1% (41/44) in round 2. Overall, a consensus was achieved on 23/29 (79.3%) questions (strong consensus on 6/29 [20.6%]). The panel strongly recommended considering surgery for limited CPM with limited liver metastases (92.5%), not altering the surgical approach in patients with mutations (91.67%), and limiting the use of IPC for unresectable CPM outside clinical trials (95%). Adjuvant SC was recommended for all patients undergoing CRS (89.47%). CRS is a therapeutic option for selected patients with CPM including those with metachronous CPM (79.49) and signet ring cell cancers (76.92%). HIPEC was recommended outside clinical trials only for patients with peritoneal cancer index 11-15(80%).
The panel recommended CRS for most indications but was very selective in recommending HIPEC and IPC outside clinical trials. These recommendations should be a useful resource in clinical decision making for clinicians treating CPM in India and regions with a similar sociodemographic background.
本手稿报告了印度腹膜表面肿瘤学发展网络和印度腹膜表面恶性肿瘤学会（INDEPSO - ISPSM）的共识结果，旨在为结直肠腹膜转移（CPM）患者管理的一些重要方面提供建议，并解决印度特有的一些问题。
采用改良德尔菲技术进行两轮投票。九个主要主题有29个问题，包括细胞减灭术（CRS）的作用、CRS的患者选择、术前检查、全身化疗（SC）的作用、伴有其他内脏转移的CPM、分子特征、腹腔内热灌注化疗（HIPEC）及其他腹腔内化疗（IPC）方式、预防策略以及CRS后的监测。若任何一个选项获得超过70票（强共识>90%），则达成共识。
邀请了48名外科（n = 41）和胃肠（n = 7）肿瘤学家；44人同意参与。第一轮的回复率为95.4%（42/44），第二轮为93.1%（41/44）。总体而言，29个问题中有23个（79.3%）达成了共识（29个问题中有6个[20.6%]达成了强共识）。专家组强烈建议，对于肝转移局限的局限性CPM考虑手术治疗（92.5%），对于有 突变的患者不改变手术方式（91.67%），在临床试验之外限制对不可切除CPM使用IPC（95%）。建议对所有接受CRS的患者进行辅助SC治疗（89.47%）。CRS是部分CPM患者的治疗选择，包括异时性CPM患者（79.49%）和印戒细胞癌患者（76.92%）。仅在临床试验之外，建议对腹膜癌指数为11 - 15的患者进行HIPEC治疗（80%）。
专家组对大多数适应证推荐CRS，但在临床试验之外对HIPEC和IPC的推荐非常有选择性。这些建议应为印度及具有类似社会人口背景地区治疗CPM的临床医生在临床决策中提供有用的参考。
