Peritoneal carcinomatosis in colorectal cancer
In recent years, the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a much-discussed option for treating peritoneal metastases from colorectal cancer. The PRODIGE 7 study, led by Prof. Dr. François Quenet, an international reference in peritoneal oncological surgery, provides very solid data that force us to reconsider the role of HIPEC with oxaliplatin in this context.
What exactly did PRODIGE 7 analyze?
A phase III, multicenter, randomized trial conducted in 17 specialized centers in France, with 265 patients aged 18–70 years with colorectal cancer and resectable peritoneal metastases (Peritoneal Cancer Index ≤25 and good general condition).
All patients underwent cytoreductive surgery seeking macroscopically complete resection and received systemic chemotherapy before and/or after surgery; the comparison was between adding HIPEC with oxaliplatin versus not adding it.
Key study results
Treatment of peritoneal carcinomatosis using only systemic chemotherapy (without cytoreductive surgery) has a median survival of only 16 months. The study showed that survival was three times higher in cases of complete cytoreduction surgery, which gives the study great relevance.
Likewise, good quality of life was observed in patients included in PRODIGE 7, notably reducing the rate of late postoperative complications. As the press headlined the day after the presentation of the study at ASCO in Chicago: "Less is More!".
What are the implications for patients?
PRODIGE 7 shows that, when complete cytoreductive surgery is achieved in expert centers and systemic chemotherapy is combined, HIPEC with oxaliplatin does not provide more survival and does carry more risk of complications.
The study is very positive as these data reinforce the idea that the pillar of treatment with curative intent for peritoneal carcinomatosis of colorectal origin is radical surgery in the hands of specialized teams, within a multidisciplinary approach and with very careful patient selection.
The role of Dr. François Quenet as an international reference
Prof. Dr. François Quenet is one of the great international names in peritoneal oncological surgery and leader of the PRODIGE 7 trial. His work has been key in providing high-quality evidence on when HIPEC adds value and when it can be avoided, helping to design safer and more rational treatments for patients with peritoneal metastases of colorectal origin.