Multidisciplinary Sequential Therapy for the Treatment of Peritoneal Surface Malignancies of Colorectal Origin: A Plea for Cooperation Between Medical and Surgical Oncologists

Excerpt

Complete and adequate surgical resection remains the hallmark therapy for primary colorectal cancer. It allows the patients to become clinically disease free, provides proper staging, and determines who should receive adjuvant therapy. Traditionally, those patients who present with unresectable metastatic disease are referred to a medical oncologist for systemic chemotherapy, and surgical resections are performed only to alleviate symptoms of bleeding, obstruction, perforation, and/or intractable pain. For 40 years, we were unable to affect the 12-month median survival of these patients treated with 5-fluorouracil and levamisole/leucovorin. However, during this time, we were able to identify a subset of patients with resectable metastatic disease to the liver who benefited from a surgical resection followed by adjuvant systemic chemotherapy. In 2005, systemic chemotherapy with newer chemotherapeutic regimens in combination with targeted agents has increased the median survival of patients with unresectable metastatic colorectal cancer to more than 20 months.1 In addition, neoadjuvant protocols with combinations of different chemotherapeutic agents have allowed a subset of patients with unresectable liver metastases (approximately 15%) to become resectable and benefit from a very reasonable 40% 5-year survival.2 These data represent the benefits of a successful interaction between medical and surgical oncologists. …