Early Postoperative Intraperitoneal Versus Hyperthermic Intraperitoneal Chemotherapy After Optimal Cytoreductive Surgery for Colorectal Cancer with Isolated Peritoneal Metastasis (ICARuS)

Abstract

The utility of cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) in treatment of peritoneal dissemination of colorectal adenocarcinoma has been a topic of controversy. In 1995, Sugarbaker and Jablonski first pioneered the idea of isolated peritoneal dissemination of appendiceal and colon adenocarcinomas as a surgical disease while establishing CRS and IPC as treatment options. Since then, a number of studies have attempted to further delineate the benefits of CRS and IPC, with evidence pointing to a survival benefit of CRS and IPC for appropriately selected patients. However, no studies have been able to adequately test the benefits of CRS plus IPC compared with CRS alone. The results from the recently published PRODIGE 7 trial attempted to address this question. The trial found that CRS without heated intraperitoneal chemotherapy (HIPEC) had noninferior survival outcomes compared with CRS plus HIPEC (30 min of oxaliplatin-based treatment), but its results have been criticized for the short treatment period, choice of agent, and dosing. The role of IPC in treating isolated peritoneal metastases from colorectal cancer continues to be debated, and the benefits of its administration are controversial. The Intraperitoneal Chemotherapy After Cytoreductive Surgery (ICARuS) trial (Fig 1), with Garrett M. Nash, MD, MPH as the principal investigator attempts to answer some of the questions regarding drug choice and delivery of local peritoneal therapy by randomizing patients to two different forms of intraperitoneal chemotherapy strategy. The trial aims to delineate a survival benefit from heated intraoperative mitomycin C for a 100-min treatment versus normothermic 5-fluorouracil (5FU)-based early postoperative IPC (EPIC).