Role of multi-modality therapy in peritoneal carcinomatosis and visceral metastasis: a case report and review of the lit
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Role of multi-modality therapy in peritoneal carcinomatosis and visceral metastasis: a case report and review of the literature Diego Vicente1*, Itzhak Avital2 and Alexander Stojadinovic2
Abstract Introduction: Treatment for advanced stage colorectal cancer with synchronous peritoneal carcinomatosis (PC) and hepatic metastasis (HM) has progressed significantly over the past 10 years. Case report: We present the case of a 39-year-old female patient with stage IV colorectal cancer with bilateral HM, pulmonary oligometastatic disease, and diffuse PC who underwent hyperthermic intraperitoneal chemotherapy (HIPEC) and complete cytoreductive surgery (CRS) for her intra-abdominal disease. The patient had an uneventful immediate post-operative recovery, and subsequently tolerated multiple cycles of adjuvant chemotherapy and percutaneous radiofrequency ablation of pulmonary lesions. At her 22-month follow-up assessment, the patient remains alive with disease. Conclusion: Current recommendations for surgical management of synchronous colorectal cancer PC and HM indicate that patients with less than three HMs, a low peritoneal cancer index (PCI), and good functional status will benefit most from CRS and HIPEC. Our patient had an elevated PCI of 12 as measured by computed tomography imaging, and five HMs (all less than 3 cm in size); however, given that her life expectancy on systemic chemotherapy was estimated to be approximately 12 months, we have observed carefully selected patients to benefit from an aggressive multi-modality approach. This case report demonstrates an all too common scenario for surgeons managing patients with advanced CRC, and highlights the importance of patient selection for surgical management as part of multidisciplinary cancer care in this patient population.
Background Over 100,000 patients were diagnosed with colorectal cancer (CRC) in 2012 in the United States, and it remains the second leading cause of cancer-related death [1]. Between 10 and 25% of patients with CRC are affected by peritoneal carcinomatosis (PC) [2,3], and 35 to 55% will have hepatic metastasis (HM) during their disease course [4,5]. While significant progress has been made in the independent management of HM and PC in CRC patients, the presence of HM in patients with known PC was traditionally considered a contraindication for cytoreductive surgery (CRS) [3,6]. Recent studies have suggested a survival benefit for CRC patients with PC and HM with a combination of * Correspondence: [email protected] 1 Department of Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA Full list of author information is available at the end of the article
complete cytoreduction (CC0) or near complete cytoreduction (CC1) [7], hyperthermic intraperitoneal chemotherapy (HIPEC), and adjuvant systemic chemotherapy in carefully selected patients [8-15]. We present the case of a CRC patient with PC and HM who underwent multi-modality thera
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