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Query: UMLS:C0699790 (colon cancer)
 28,837 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Assuming that peritoneal carcinomatosis is a local/regional dissemination of disease, a treatment strategy utilizing cytoreductive surgery and intraperitoneal chemotherapy was developed to treat colon cancer. In an attempt to improve knowledge of the mechanisms controlling abdominal and pelvic recurrences and for better selection of patients for reoperation, we studied those patients who had a second-look surgery following cytoreduction for peritoneal carcinomatosis from colorectal cancer. A group of 18 patients with symptoms and signs of recurrent peritoneal carcinomatosis were treated with reoperative surgery after definitive cytoreduction and intraperitoneal chemotherapy. An analysis of clinical features of these patients was performed using survival as an endpoint for evaluation of prognosis. The data suggest that the clinical features to be used to select patients for a second-look procedure after prior cytoreduction were the completeness of resection at the time of initial cytoreduction (p = 0.04) and the completeness of resection at the time of the second look (p = 0.066). In addition, a limited extent of peritoneal carcinomatosis distribution found at the time of the second look predicted a favorable result. A new objective assessment of peritoneal carcinomatosis, the peritoneal cancer index, was found to be of help during patient selection (p = 0.066). We concluded that second-look surgery with potential curative intent should be considered in patients who had a complete initial cytoreduction and those in whom total removal of the recurrence is judged possible at the time of the second look. At the time of abdominal exploration, a limited distribution and volume of peritoneal carcinomatosis as defined by the peritoneal cancer index should be considered. Palliative debulking procedures should be used to alleviate symptoms in other patients.
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PMID:Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. 984 59

Peritoneal carcinomatosis occurs in about 10% of patients with colon cancer. Patients with progressive disease develop complications, with a median survival of 9 months. Our goal is to present a new quantitative scoring system by which to evaluate patients with peritoneal carcinomatosis. The Peritoneal Cancer Index and Completeness of Cytoreduction Score represent quantitative and prognostic indicators that permit the creation of a clinical pathway. Based on the scores, patients can undergo systemic chemotherapy, exploratory laparotomy or cytoreductive surgery. If there is a complete cytoreduction, perioperative intraperitoneal chemotherapy is given and these patients are considered potential long-term survivors.
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PMID:[Elective surgery in recurrent colon cancer with peritoneal seeding: when to and when not to proceed]. 1021 64

Although cancer surgery has been of great benefit to patients with large bowel cancer, a flaw that has caused the death of countless patients has gone unrecognized. Although surgeons have dealt successfully with the primary tumor, they have neglected to treat microscopic residual disease. Persistent cancer cells within the abdomen and pelvis are responsible for the death of 30-50% of the patients who die with this disease and for quality of life consequences that result from intestinal obstruction caused by cancer recurrence at the resected site and on peritoneal surfaces. New surgical techniques for large bowel cancer resection minimize the surgery-induced microscopic residual disease that may result from surgical trauma. New developments in exposure, hemostasis, adequate lymphadenectomy, and qualitatively superior margins of excision have occurred. Clinical data show that a 40% improvement in survival with an optimization of surgical technique is possible. Not only should the surgical event for primary colon and rectal cancer be optimized, but also the successful treatment of peritoneal carcinomatosis should be pursued. Resected site disease and peritoneal carcinomatosis can be prevented through the use of perioperative intraperitoneal chemotherapy in patients at high risk of persistent microscopic residual disease. These are patients with perforated cancer, positive peritoneal cytology, ovarian involvement, tumor spill during surgery, and adjacent organ involvement. Patients with established peritoneal carcinomatosis can be salvaged with an approximate 50% long-term survival rate if the timely use of peritonectomy procedures, intraperitoneal chemotherapy, and knowledgeable patient selection are utilized. Peritonectomy procedures allow the removal of all visible peritoneal carcinomatosis with acceptable surgical morbidity (25%) and mortality (1.5%) rates. Heated intraoperative intraperitoneal chemotherapy using mitomycin C, in addition to early postoperative intraperitoneal 5-fluorouracil, can eradicate microscopic residual disease in the majority of patients. The peritoneal cancer index, which quantitates colon cancer peritoneal carcinomatosis by distribution and by lesion size, must be used in the selection of patients who may benefit from these advanced oncologic surgical treatment strategies. The completeness of the cytoreduction score is the most powerful prognostic indicator in this group of patients. The surgeon must be aware that there are no long-term survivors unless complete cytoreduction occurs. With a combination of proper techniques for the resection of primary disease, peritonectomy procedures for the removal of all visible peritoneal implants, intraoperative and early postoperative chemotherapy for the eradication of microscopic residual disease, and quantitative tools for proper patient selection, one can optimize the surgical treatment of patients with large bowel cancer.
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PMID:Successful management of microscopic residual disease in large bowel cancer. 1035 54

The efficacy of cytoreductive approach for colon cancer with carcinomatosis was assessed. 34 patients (the main group) underwent colon resections, peritonectomy, omentectomy and intraperitoneal chemotherapy (mitomycin and 5-fluorouracil). 22 patients (control group) underwent palliative colon resections only. The spread of peritoneal dissemination was assessed in all patients, basing on Peritoneal Cancer Index (PCI). It was found, that the rate of postoperative morbidity is higher in the main group, but it was not accompanied by enhanced postoperative mortality. It was also detected, that cytoreductive approach permits to prolong the survival (17.0 +/- 3.5 months in main group vs. 7.5 +/- 2.1 months in controls). The main prognostic factor in these patients was the PCI. The most favorable prognosis is identified if PCI < 5 (few discrete implants are present); the survival in this group was 23.0 +/- 4.5 months and disease-free interval was 14.0 +/- 2.5 months. When PCI was higher then 5, the survival was 14.5 +/- 2.5 months and disease-free interval was 7.0 +/- 1.3 months.
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PMID:[Cytoreductive surgery with intraperitoneal chemotherapy in patients with colon cancer and peritoneal carcinomatosis]. 1274 21

Free malignant cells, which are frequently detected in the washing liquid from the peritoneal cavity before and after resection of human colorectal cancer, are suspected to cause recurrent peritoneal cancer. We carried out an experimental study to compare the prophylactic efficacy of washing the peritoneum with several anticancer drugs and the antiseptic povidone-iodine against the development of peritoneal carcinomatosis from colonic origin in rats and nude mice. The in vitro anticancer activity of a short, 15-minute exposure of pirarubicin, doxorubicin, 5-fluorouracil, cisplatin, mitomycin C, and 1% povidone-iodine was first evaluated by an MTT assay on DHD/K12/PROb rat and LS174T human colon cancer cells. For the in vivo experiments, BDIX rats were inoculated intraperitoneally (i.p.) with 1 x 10(6) DHD/K12/PROb cells followed by peritoneal scarring and a colocolic anastomosis. A 15-minute peritoneal washing with the anticancer drugs or povidone-iodine was then performed. Nude mice were i.p.-inoculated with 1 x 10(7) LS174T human cells and treated 2 hours later with i.p. pirarubicin. Only pirarubicin, mitomycin C, and povidone-iodine were fully cytotoxic in vitro against DHD/K12/PROb rat colon cancer cells. In contrast to pirarubicin and povidone-iodine, mitomycin C was not completely active against LS174Tcells. In vivo, pirarubicin cured DHD/K12/PROb-inoculated rats, even at the site of the peritoneal scarring and intestinal anastomosis. i.p. pirarubicin prevented the development of peritoneal carcinomatosis and liver metastasis in LS174T-inoculated mice. i.p. washing with pirarubicin cured 2-day-old, but not 7-day-old, peritoneal carcinomatosis in rats. Short exposure to i.p. pirarubicin is nontoxic and more active than povidone-iodine and other anticancer drugs in preventing the development of peritoneal carcinomatosis from colonic origin in rats and mice. The prophylactic effect of preoperative peritoneal washing with pirarubicin on the development of recurrent peritoneal cancer should be evaluated in a randomized clinical trial.
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PMID:Prevention of peritoneal carcinomatosis from colon cancer cell seeding using a pirarubicin solution in rats and nude mice. 1508 2

Peritoneal surface malignancy usually results from implantation of gastrointestinal cancer. In the past, this clinical situation was treated with palliative intent. A definitive approach to peritoneal surface malignancy involves peritonectomy procedures, visceral resections, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The quantitative prognostic indicators necessary for valid clinical judgements include the cancer histopathology (invasive vs. expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment. In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 45% with selected patients. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit. The definitive prognostic indicator was the complete cytoreduction. Oncologists must seek new knowledge regarding the management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies; in contrast all historical controls show 0% long-term survival. Additional adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.
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PMID:Peritoneal surface oncology: review of a personal experience with colorectal and appendiceal malignancy. 1600 67

The prognosis of peritoneal spread from gastrointestinal cancer and subsequent malignant ascites is poor, and current medical treatments available are mostly ineffective. Targeted chemotherapy with intraperitoneal prodrug activation may be a beneficial new approach. L293 cells were genetically modified to express the cytochrome P450 enzyme 2B1 under the control of a cytomegalovirus immediate early promoter. This CYP2B 1 enzyme converts ifosfamide to its active cytotoxic compounds. The cells are encapsulated in a cellulose sulfate formulation (Capcell; Bavarian Nordic, Martinsried, Germany). Adult Balb/c mice were inoculated intraperitoneally (i.p.) with 1 x 10(6) colon cancer cells, previously transfected with GFP to emit a stable green fluorescence, by injection into the left lower abdominal quadrant. Two or five day's later animals were randomly subjected to either i.p. treatment with ifosfamide alone or ifosfamide combined with microencapsulated CYP2B1 expressing cells. Peritoneal tumour volume and tumour viability were assessed 10 days after tumour inoculation by means of fluorescence microscopy, spectroscopy and histology. Early i.p. treatment with ifosfamide and CYP2B1 cells resulted in a complete response. Treatment starting on day five and single-drug treatment with ifosfamide resulted in a partial response. These results suggest that targeted i.p. chemotherapy using a combination of a prodrug and its converting enzyme may be a successful treatment strategy for peritoneal spread from colorectal cancer. In summary, by using GFP-transfected colon 26 tumour cells in mice we established a well reproducible animal model of metastatic peritoneal cancer. Fluorescent imaging of GFP-transfected tumour was used to demonstrate tumour distribution in the peritoneal cavity and to estimate tumour growth and tumour response to treatment in this model. The application of Capcell and ifosfamide into the peritoneal cavity is a safe and well tolerated procedure in animal models and may help to target chemotherapeutic agents specifically at metastatic peritoneal cancer.
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PMID:Targeted intraabdominal chemotherapy for peritoneal carcinomatosis. 1763 75

There is an increasing evidence showing that in selected patients with peritoneal carcinomatosis cytoreductive surgery and hyperthermic intraperitoneal chemotherapy may improve survival. Adequate patient selection is crucial to obtain a complete macroscopic cytoreduction, a leading predictor of patient outcome. However, selection is a very difficult process and is associated with a significant learning curve. Many selection criteria have to be assessed in each patient: performance status, comorbiditites, response to previous chemotherapies, histology grading, and presence of extra-abdominal or liver metastases, small bowel involvement, and tumor volume assessed by the peritoneal cancer index. All these factors have to be discussed interdisciplinary and with the patient to create an individualized treatment strategy. It is difficult to decide the relative importance of each selection criteria. However, completeness of cytoreduction, tumor volume, and histology grading are most important in many multivariate analysis independent prognostic factors. For appropriate selected patients with peritoneal carcinomatosis arising from appendiceal and colon cancer, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy should be considered standard of care.
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PMID:Patient selection for a curative approach to carcinomatosis. 1955 10

Peritoneal carcinomatosis (PC) is difficult to treat and many efforts have been made to identify effective and safe treatments. One hypothetical way to increase the efficacy of chemotherapy regarding tumor eradication or tumor control is to apply chemotherapeutic agents into the abdomen in the form of a pressurized aerosol, taking advantage of the physical properties of gas and pressure. This new approach for treatment of PC is based on the assumption that (1) intraabdominal application of chemotherapy under pressure will enhance tumor drug uptake and (2) aerosolizing and spraying chemotherapy will enhance the area of peritoneal surface covered by the drug, (3) resulting in an improved anti-tumor efficacy. Ex vivo and in vitro models have tested this approach and have demonstrated good peritoneal cavity coverage, deep peritoneal drug infiltration, and technical feasibility. Occupational safety of this procedure has also been established. First evidence in humans with peritoneal cancer from ovarian cancer, gastric cancer, colon cancer, appendiceal cancer, and pseudomyxoma peritonei has been obtained suggesting clinical antitumor activity and procedural safety of repeated pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin. We hypothesize that PIPAC can effectively treat PC and will hence become part of the surgical and chemotherapeutical treatment spectrum of this disease in the future.
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PMID:Pressurized intraperitoneal aerosol chemotherapy as an innovative approach to treat peritoneal carcinomatosis. 2627 56

Peritonitis carcinomatosa is an advanced and intractable state of gastrointestinal and ovarian cancer, where mechanistic elucidation might enable the development of more effective therapies. Peritoneal dissemination of this type of malignancy has been generally thought to initiate from "milky spots" of primitive lymphoid tissues in the peritoneal cavity. In this study, we offer evidence challenging this idea, based on the finding that tumor implantation and directional dissemination was not required for the presence of milky spots, but rather SCF/CXCL12-expressing niche-like cells located at the border regions of perivascular adipose tissue. Interestingly, we found that peritoneal cavity lavage fluid, which specifically contains peritoneal collagen type IV and plasma fibronectin, dramatically facilitated spheroid formation of murine and human colon cancer cells. Spheroid formation strongly induced the expression of CXCR4 in an Sp1-dependent manner to promote niche-directed metastasis. Notably, disrupting sphere formation or inhibiting Sp1 activity was sufficient to suppress tumor dissemination and potentiated chemosensitivity to 5-fluorouracil. Our findings illuminate mechanisms of peritoneal cancer dissemination and highlight the Sp1/CXCR4/CXCL12 signaling axis as a rational target for the development of therapeutics to manage this intractable form of malignancy.
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PMID:Peritoneal Dissemination Requires an Sp1-Dependent CXCR4/CXCL12 Signaling Axis and Extracellular Matrix-Directed Spheroid Formation. 2674 23


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