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Bowel cancer that has seeded the lining of the abdomen responds badly to drugs but well to a complete operation, and the heated chemotherapy that everyone added turned out to do nothing. What decides the outcome is whether the disease is found while it is still limited and whether the patient reaches a centre that can remove all of it.
Verwaal's randomised trial put median survival at 22.3 against 12.6 months with cytoreduction and heated intraperitoneal oxaliplatin, at 8 percent treatment-related mortality, and its own subgroup analysis showed the result belonged to patients with fewer than six of seven abdominal regions involved and to macroscopically complete resections. PRODIGE 7 then randomised the heated chemotherapy away in 265 patients who had all had complete cytoreduction: 41.7 against 41.2 months, hazard ratio 1.00, with more grade 3 complications at 60 days in the heated arm.
What that leaves is a surgical result gated by selection. Both trials enrolled patients under 70 with a Peritoneal Cancer Index of 25 or less; the index at presentation is the single strongest determinant of whether complete cytoreduction is possible, and it is a function of how early the peritoneal spread is found. Cross-sectional imaging is poor at low-volume peritoneal disease, and most of it is discovered at an operation done for another reason.
Complete cytoreductive surgery with modern systemic chemotherapy gives a median survival over 40 months in selected patients with peritoneal metastases, and the heated intraperitoneal oxaliplatin adds only late complications.
The trial that created peritoneal surface malignancy as a speciality, and the reason patients with limited peritoneal disease are referred to designated centres; PRODIGE 7 later showed the benefit belongs to the surgery, not to the heated chemotherapy.
Shares Surgery and radiotherapy cure most, get least, Oxaliplatin, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, FOLFOX (5-FU, leucovorin, oxaliplatin) and the tag colorectal-evidence.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, MRD / molecular residual disease testing and the tag colorectal-evidence.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, FOLFOX (5-FU, leucovorin, oxaliplatin) and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, Oxaliplatin, MRI, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Colorectal cancer and the tag colorectal-evidence.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, MRD / molecular residual disease testing and the tag colorectal-evidence.
Shares Minimal / molecular residual disease (MRD), Circulating tumour DNA (ctDNA), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, MRD / molecular residual disease testing and the tag colorectal-evidence.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, MRI, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.