Improving the HIPEC treatment delivery for colorectal cancer patients with peritoneal metastasis: The heat and time is on

This thesis, entitled ‘Improving the HIPEC treatment delivery for colorectal cancer patients with peritoneal metastasis – THE HEAT AND TIME IS ON’ provides new insights towards treatment optimization for colorectal cancer (CRC) patients with peritoneal metastasis (PM). In the Netherlands, CRC is the third most common cancer with around 13,000 new patients each year. The survival rate at an early stage of disease is around 90%, but dramatically decreases when metastases occur in other organs. Besides the liver and lungs, metastases might develop throughout the peritoneal cavity. When left untreated, the overall survival of patients with PM is only 5 months. A valuable treatment option with the intent to prolong the survival of these patients is the combination of cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC). A prolonged survival of 10-30 months was shown in several clinical studies performing CRS followed by HIPEC. During CRS, visible tumor depositions are removed, followed by a 30-90 minute HIPEC treatment, which means circulating a heated (40-43 °C) chemotherapeutic solution through the peritoneal cavity, to intentionally eradiate microscopic cancer lesions that are left behind after CRS. Although, studies showed that CRS followed by HIPEC prolonged the survival of CRC patients with PM, the role of HIPEC is currently under debate since recently randomized clinical trials did not show any survival benefit after the application of HIPEC. The goal of this thesis is to provide new insights that can help to improve the HIPEC delivery for CRC patients with PM.