Regional therapy trials in peritoneal metastases: The path to standardization of care: Introduction

Effective cancer prevention requires the discovery and intervention of a factor critical to cancer development. Here we show that ovarian progesterone is a crucial endogenous factor inducing the development of primary tumors progressing to metastatic ovarian cancer in a mouse model of high-grade serous carcinoma (HGSC), the most common and deadliest ovarian cancer type. Blocking progesterone signaling by the pharmacologic inhibitor mifepristone or by genetic deletion of the progesterone receptor (PR) effectively suppressed HGSC development and its peritoneal metastases. Strikingly, mifepristone treatment profoundly improved mouse survival (∼18 human years). Hence, targeting progesterone/PR signaling could offer an effective chemopreventive strategy, particularly in high-risk populations of women carrying a deleterious mutation in the BRCA gene.

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The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases

Surgical Endoscopy ◽

10.1007/s00464-019-06984-8 ◽

2019 ◽

Vol 34 (5) ◽

pp. 2040-2049

Author(s):

Haythem Najah ◽

Brice Malgras ◽

Anthony Dohan ◽

Caroline Gronnier ◽

Clarisse Eveno ◽

...

Keyword(s):

Single Incision ◽

Peritoneal Metastases

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Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

BMC Cancer ◽

10.1186/s12885-021-08168-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. P. Engbersen ◽

C. J. V. Rijsemus ◽

J. Nederend ◽

A. G. J. Aalbers ◽

I. H. J. T. de Hingh ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Diagnostic Laparoscopy ◽

Controlled Trial ◽

Peritoneal Metastases ◽

Surgical Staging ◽

Mri Findings ◽

Mri Staging ◽

Multicenter Randomized Controlled Trial ◽

Colorectal Cancer Patients

Abstract Background Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging. Methods The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis. Conclusion This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC. Trial registration Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175.

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