Patient Selection for Hyperthermic Intraperitoneal Chemotherapy in Patients With Colorectal Cancer: Consensus on Decision Making Among International Experts
| Autor: | Claudio Almeida Quadros, Diane Goéré, Yan Li, Janina Eden, Thomas Steffen, David L. Morris, Beate Rau, Pompiliu Piso, Paul H. Sugarbaker, Brandon Moran, Olivier Glehen, Ignace H. J. T. de Hingh, Markus Glatzer, Yutaka Yonemura, Lana Bijelic, Paul Martin Putora |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Consensus Colorectal cancer Clinical Decision-Making Hyperthermic Intraperitoneal Chemotherapy 03 medical and health sciences 0302 clinical medicine Older patients medicine Humans Peritoneal Carcinomatosis Index In patient Expert Testimony Peritoneal Neoplasms Aged business.industry Patient Selection General surgery Decision Trees Gastroenterology Cytoreduction Surgical Procedures medicine.disease Colorectal surgery Oncology 030220 oncology & carcinogenesis Practice Guidelines as Topic Conventional PCI 030211 gastroenterology & hepatology Hyperthermic intraperitoneal chemotherapy Colorectal Neoplasms Cytoreductive surgery business |
| Zdroj: | Clinical Colorectal Cancer. 19:277-284 |
| ISSN: | 1533-0028 |
| Popis: | Background Colorectal cancer (CRC) treatment in patients with peritoneal metastases is complex. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are under debate. The aim of this study was to assess the consensus among international experts for decision-making regarding CRS/HIPEC in CRC patients. Materials and methods Twelve of 15 experts provided their decision algorithms for CRS/HIPEC for patients with or at high risk for peritoneal metastases from CRC. Based on the objective consensus methodology, the results were transformed into decision trees, which then provided information on the consensus and discordance. Results There was only one scenario in which the consensus on performing HIPEC reached 100%, which was when treating young patients with complete cytoreduction and a peritoneal carcinomatosis index (PCI) of less than 16 in the presence of certain risk factors (RFs). Five major decision criteria were identified and displayed: age, PCI, completeness of cytoreduction (CC), extent of extraperitoneal metastases (EoM) and, in the case of nonverified extraperitoneal metastases, further RFs. There was consensus to refrain from using HIPEC in older patients with a high PCI, and the consensus further increased when addressing incomplete cytoreduction and extensive EoM. Conclusion A definite consensus concerning the use of HIPEC was only determined for very selected scenarios. These findings can be used for general guidance, but due to the heterogeneity of each individual situation and the impracticality to present this information through decision trees, as well as the unclear future of the role of HIPEC in the adjuvant setting, a one-on-one transfer to daily clinical practice cannot be achieved. |
| Databáze: | OpenAIRE |
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