Peritoneal carcinomatosis of gastrointestinal origin: natural history and treatment options

Abstract

Background: Peritoneal carcinomatosis (PC) is a challenging consequence of certain malignancies, associated with a poor prognosis and limited treatment options. Generally, PC has been treated similarly to metastatic cancers of the primary tumor, but associated with worse outcomes when compared to other sites of metastatic disease from the same primary tumor site. With supportive care alone, the median survival with PC is 3 – 6 months. More recently, a limited number of centers have reported success with cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in a subset of patients with PC, resulting in improved survival compared with historical controls. Objectives: This paper outlines the natural history of PC, and surgical, chemotherapeutic, and combined modality treatment options, with a focus on PC of colorectal (CRC) and appendiceal origin. Results: At this time, the ‘standard’ treatment for PC remains incompletely defined. As such, the optimal management strategies for both ‘localized’ and unresectable disease is unclear. CS + HIPEC is a promising treatment with a significant survival benefit of 10 months over systemic therapy alone demonstrated in a clinical trial of patients with CRC. Conclusion: Well-designed clinical trials need to continue to be offered to improve care and determine the optimal treatment strategies for PC.

Keywords::

• cytoreductive surgery
• hyperthermic intraperitoneal chemotherapy
• peritoneal carcinomatosis
• Pseudomyxoma peritonei
• systemic therapy