Advances in the Management of Peritoneal Surface Malignancies

Dear Colleagues,

Peritoneal surface malignancies, whether primary or secondary, continue to be difficult to manage. Despite the fact that there have been significant successes in the treatment of hematologic-based metastases, the peritoneum surface remains relatively elusive due to a blood–peritoneal barrier. However, in combination with effective systemic therapies, progress has been made with the addition of cytoreductive surgery and hyperthermic intraperitoneal therapy (CRS-HIPEC). In the case of colorectal cancer, patients with isolated metastatic peritoneal carcinomatosis can now achieve a survival rate of 40–50% in select patients who receive systemic therapy combined with CRS-HIPEC; this is similar to the survival of patients with isolated liver metastases.

The utilization of CRS-HIPEC remains controversial in some cases due to a lack of level one evidence showing a survival benefit for some primary disease sites. Cytoreductive surgery alone, especially when all gross disease is removed, consistently shows a survival advantage in the multimodality treatment of peritoneal carcinomatosis for many disease sites. However, the addition of hyperthermic intraperitoneal chemotherapy has been questioned as providing a survival advantage. Interestingly, in peritoneal carcinomatosis from ovarian cancer, the addition of hyperthermic intraperitoneal chemotherapy to cytoreductive surgery has consistently shown an inherent survival value in several large randomized prospective surgery studies despite this disease having only recently been studied for this approach.

The multimodality management of peritoneal surface malignancies remains in its infancy. Multiple variables require further research, and more clinical trials are needed. The use of CRS-HIPEC needs to become more standardized before it is universally accepted as an integral component in managing peritoneal surface malignancies from specific primary sites of origin. Important topics need to be addressed such as appropriate patient selection, including patient and tumor molecular correlates, that can lead to individualized care. Furthermore, the standardization of CRS-HPEC techniques needs to be fine-tuned, including delivery systems, agents, dosages, length of HIPEC administration, and temperatures. Importantly, ideal sequencing of CRS-HIPEC with systemic therapy needs to be established.

This Special Issue of Cancers aims to include original studies and reviews of the important topics in peritoneal surface malignancies and their treatment, including CRS-HIPEC and systemic therapy. The integration of surgery, systemic therapy, and other modalities will require cooperation between the various types of providers. Many in the field have strong opinions about the management of peritoneal surface malignancies, which could hinder progress. Providers in several fields need to remain open-minded. Finally, several studies have shown that only institutions with the appropriate resources and volume of cases should take on the more complex cases of peritoneal surface malignancies.

Prof. Dr. Mazin Al-Kasspooles
Guest Editor

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• peritoneal surface malignancies
• cytoreductive surgery
• hyperthermic intraperitoneal therapy
• systemic therapy
• multimodality management