The European contribution to 'Sugarbaker's protocol' for the treatment of colorectal peritoneal carcinomatosis
| Autor: | Carlos Fernandez-del Castillo, Elena Martín, José Luis Fernández, I. Cendoya, A. Gómez Portilla, A. Lirola, Elena Fernández, N. Guede, O. Rua, A. Gil, C. Gómez Martínez de Lecea, N. Ruiz de Alegría, Iñaki Larrabide, Erika Romero, Mercedes Valdovinos, Jesús Muriel, M Kvadatze, Nuria Moraza, C. Martínez de Lecea, L. Magrach, I. Olabarria, M. A. Ulibarrena |
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| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Organoplatinum Compounds Adenocarcinoma Irinotecan Intraperitoneal chemotherapy Antineoplastic Combined Chemotherapy Protocols medicine Combined Modality Therapy Humans Multicenter Studies as Topic Cytoreductive surgery Hyperthermia Infusions Parenteral Survival rate Peritoneal Neoplasms Randomized Controlled Trials as Topic Retrospective Studies Salvage Therapy business.industry Colorectal carcinomatosis General surgery Liver Neoplasms Gastroenterology Induction chemotherapy Retrospective cohort study General Medicine Hyperthermia Induced Neoadjuvant Therapy Surgery Oxaliplatin Clinical trial Europe Survival Rate Regimen Treatment Outcome Clinical Trials Phase III as Topic Chemotherapy Adjuvant Camptothecin Fluorouracil business Colorectal Neoplasms medicine.drug |
| Zdroj: | Revista Española de Enfermedades Digestivas v.101 n.2 2009 SciELO España. Revistas Científicas Españolas de Ciencias de la Salud instname |
| ISSN: | 1130-0108 |
| Popis: | Introduction In 1981, Dr. PH Sugarbaker, challenging oncological orthodoxy, considered carcinomatosis to be a locoregional stage of the disease that was still susceptible to treatment with curative intent. To this end he developed a new therapeutic alternative based on the combined treatment. The macroscopic disease treated by maximum radical oncological cytoreductive surgery (through the peritonectomies described by him), followed by treatment of the residual microscopic disease with the direct intra-abdominal application of intraoperative chemotherapy with locoregional intensification, modulated by hyperthermia and early normothermic postoperative intra-abdominal chemotherapy. Using this new therapeutic regimen, known as "Sugarbaker s Protocol", his group has reported 45% survival rates in carcinomatosis of colorectal origin at 5 years, and, in selected groups of patients, 50% survival rates at 5 years. The scientific community, however, has criticized these results considering that: it is a personal experience, with a not homogenous treatment protocol with developmental modifications over time, that it is a retrospective non-randomized study, and finally that the cytostatics used in his protocol are obsolete. Various European groups have replied to these main criticisms confirming the good results that this new therapeutic alternative offers for patients with carcinomatosis of colorectal origin. The purpose of this article is to present these contributions. Material and methods All the articles published in the English language by European groups in the world s medical literature have been reviewed using the Pubmed-MEDLINE database to identify the relevant articles related to the treatment of carcinomatosis of colorectal origin using cytoreduction and intraperitoneal chemotherapy from January 1980 to January 2008. Results The European contribution during these 25 years in favour of the "Sugarbaker s Protocol" has consisted fundamentally in: a) one multicenter retrospective study; b) two randomized prospective phase III studies; and c) the use of oxaliplatin and irinotecan as new cytostatic agents in the protocols for intraperitoneal chemotherapy. At the same time, two new transcendental European contributions have been made in which the possibility has been considered of combined simultaneous treatment for patients with hepatic metastases and carcinomatosis, and the introduction, as a selection factor, of patients responsive to intravenous induction chemotherapy within the regimen of sandwich treatment (with systemic neoadjuvant and adjuvant chemotherapy) complementary to intraperitoneal chemotherapy. Conclusions The results obtained by European groups using "Sugarbaker s protocol" and "Elias protocol" with oxaliplatin compel us to request that these treatments be considered by all professionals involved in the treatment of patients with colorectal carcinomatosis as the best treatment currently available for this condition. Furthermore a randomized, prospective, multicenter study should be carried out to clarify its value and the degree of scientific evidence. A validation of this treatment will change, in the future, the dogmatic consideration of carcinomatosis as an incurable disease stage. |
| Databáze: | OpenAIRE |
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