Patient Selection for Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Cancer: Consensus on Decision Making Among International Experts.

Autor: Steffen T; Department of Surgery, Hospital of the Canton of St Gallen, St Gallen, Switzerland. Electronic address: thomas.steffen@kssg.ch., Eden J; Department of Surgery, Hospital of the Canton of St Gallen, St Gallen, Switzerland., Bijelic L; Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA., Glatzer M; Department of Radiation Oncology, Hospital of the Canton of St Gallen, St Gallen, Switzerland., Glehen O; Department of Digestive Surgery, Hospices Civils de Lyon, Lyon, France., Goéré D; Department of Surgery, Gustave Roussy Institute, Villejuif, France., de Hingh I; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Li Y; Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Beijing, People's Republic of China., Moran B; Peritoneal Malignancy Institute, North-Hampshire Hospital, Basingstoke, United Kingdom., Morris D; Department of Surgery, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia., Piso P; Department of Surgical Oncology, Hospital Barmherzige Brueder, Regensburg, Germany., Quadros C; Surgical Oncology Unit, São Rafael Hospital, Salvador, Bahia, Brazil., Rau B; Department of General Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany., Sugarbaker P; Peritoneal Surface Oncology Unit, MedStar Washington Hospital Center, Washington, DC., Yonemura Y; Peritoneal Metastases Center, Kishiwada Tokushukai Hospital, Osaka, Japan., Putora PM; Department of Radiation Oncology, Hospital of the Canton of St Gallen, St Gallen, Switzerland.
Jazyk: angličtina
Zdroj: Clinical colorectal cancer [Clin Colorectal Cancer] 2020 Dec; Vol. 19 (4), pp. 277-284. Date of Electronic Publication: 2020 Jul 15.
DOI: 10.1016/j.clcc.2020.06.010
Abstrakt: Background: Colorectal cancer (CRC) treatment for patients with peritoneal metastases is complex. The use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has continued to be debated. The aim of the present study was to assess the consensus among international experts for decision-making regarding the use of CRS and HIPEC for patients with CRC.
Materials and Methods: Of 15 experts invited, 12 had provided their decision algorithms for CRS and HIPEC for patients with, or at high risk of, peritoneal metastases from CRC. Using the objective consensus method, the results were transformed into decision trees to provide information on the consensus and discordance.
Results: Only 1 scenario was found for which the consensus on performing HIPEC had reached 100%. The scenario was the treatment of young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of < 16 in the presence of certain risk factors. Five major decision criteria were identified: age, PCI, completeness of cytoreduction, extent of extraperitoneal metastases (EoMs), and, in the case of unverified EoMs, additional risk factors. Consensus was found regarding refraining from using HIPEC for older patients with a high PCI. The consensus further increased when addressing incomplete cytoreduction and an extensive extent of EoMs.
Conclusion: A definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance; however, owing to the heterogeneity of each individual situation, the impracticality of presenting the information through decision trees, and the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice could not be achieved.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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