Rationale for a Combined Treatment for Peritoneal Surface Malignancy
Lack of Clinical Evidence for Alternative Management Strategies

There are many reasons why this combined approach to the management of peritoneal surface malignancy has continued to grow. Perhaps the greatest impetus toward further development of CRS and perioperative chemotherapy (POC) is a near total lack of scientific data to support an alternative treatment plan. Level 1 data regarding the effectiveness of systemic chemotherapy for peritoneal carcinomatosis has not been published.8 The response to systemic chemotherapy is not the same for all anatomic sites of metastatic disease. It must be concluded that no reliable data from the medical oncology literature regarding the benefits of systemic chemotherapy for peritoneal carcinomatosis from gastrointestinal cancer are available. In sharp contrast, over the past decade, multiple phase 2 and 3 studies with CRS and POC report a median survival benefit two to four times greater than survival using systemic chemotherapy.

Natural History Studies Document the Importance of Local-Regional Progression

A second strong rationale for the emergence of CRS and POC as a valid treatment option comes from natural history studies. In a proportion of patients, recurrence of the primary cancer isolated to the surfaces of the abdomen and pelvis is a reality. Patients with primary or recurrent disease at the resection site and on peritoneal surfaces in the absence of hepatic metastases or systemic metastases are appropriate for treatment by CRS and POC. Isolated peritoneal surface progression of abdominal or pelvic malignancy is not ...

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