LETTERS TO THE EDITOR

 

From utopia to reality: increased survival in peritoneal carcinomatosis treated with cytoreduction and hyperthermic intraperitoneal chemotherapy

De la utopía a la realidad: incremento de supervivencia en la carcinomatosis peritoneal tratada mediante citorreducción y quimioterapia intraperitoneal hipertérmica

 

 

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Key words: Colorectal carcinoma. Peritoneal metastases. Chemotherapy. Hyperthermic intraperitoneal chemotherapy. Cytoreduction. Carcinomatosis.

Palabras clave: Cáncer colorrectal. Metástasis peritoneales. Quimioterapia. HIPEC. Citorreducción. Carcinomatosis.

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Dear Editor,

We have read with great interest the article by Illán et al. (1) entitled "Long survival in a patient with metastatic colorectal carcinoma: reality or utopia?". This article describes the case of a 42-year-old patient with mucinous-type colon adenocarcinoma who had tumor recurrence with peritoneal metastases 18 months after resection of the primary tumor and adjuvant chemotherapy. The patient underwent multiple metastasectomies and several lines of chemotherapy, and died 27 months after the recurrence.

As described by the authors, survival reaches an average of 24 months after treatment with the latest cytostatics and molecular targets (2) in colon cancer patients with systemic disease. The treatment of peritoneal carcinomatosis has changed substantially during recent years. The application of radical peritoneal cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) has transformed this almost terminal disease into a salvageable disease in a quarter of patients. There are randomized and multi-center studies which have demonstrated the lower response rate of peritoneal metastases to systemic chemotherapy alone (3). Thanks to cytoreduction and HIPEC therapies, a survival rate that ranges between 30.1 months (4) and 62.7 months (5) is now achieved. Nowadays, these patients can benefit from treatment by multidisciplinary units that allow the combination of surgical cytoreduction and HIPEC with systemic chemotherapy. This type of management offers the best survival rate and is the treatment of choice in selected patients (2).

 

Juan José Segura-Sampedro and Rafael Morales-Soriano
Peritoneal Oncologic Surgery Unit. Digestive Surgery Department.
Hospital Universitario Son Espases.Palma de Mallorca, Spain.
Malignant Peritoneal Disease Research Group. Health Research
Institute of Balearic Islands (IdISBa). Palma de Mallorca, Spain

 

References

1. Illán A, Aires J, Quintana L. Long survival in a patient with metastatic colorrectal carcinoma: Reality or utopia? Rev Esp Enferm Dig 2017;109(9):667. DOI: 10.17235/reed.2017.4817/2016.         [ Links ]

2. Bhatt A, Goéré D. Cytoreductive surgery plus HIPEC for peritoneal metastases from colorectal cancer. Indian J Surg Oncol 2016;7:177-87. DOI: 10.1007/s13193-016-0499-z.         [ Links ]

3. Franko J, Shi Q, Goldmannn CD, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: A pooled analysis of North Central Cancer Treatment Group Phase III Trials N9741 and N9841. J Clin Oncol 2012;30(3):263-7. DOI: 10.1200/JCO.2011.37.1039.         [ Links ]

4. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: Retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 2010;28:63-8. DOI: 10.1200/JCO.2009.23.9285.         [ Links ]

5. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol 2009;27:681-5. DOI: 10.1200/JCO.2008.19.7160.         [ Links ]