Colorectal cancer (CRC) is the third most common cancer diagnosed in the United States. Unfortunately, up to 20% of new CRC cases have metastases at the time of diagnosis. The most common sites of metastatic disease in CRC are the liver, lung, and peritoneum. Close to 5% of patients with CRC will present with peritoneal carcinomatosis (PC).
One of the many challenges of treating PC in stage IV CRC patients is drug delivery. It is often difficult to attain adequate drug levels within the peritoneum. If chemotherapy doses are subsequently increased in attempts to raise drug concentrations, the patient is exposed to more systemic side effects. HIPEC aims to deliver chemotherapy directly to the peritoneum, which can increase local drug concentrations, as well as reduce the total systemic exposure from the chemotherapy.
CRS and HIPEC do appear to have promising data when used in the optimal patient population. It is important, when considering CRS and HIPEC, that a patient reviews an institution’s experience with this collaborative treatment approach.