The changing landscape of colorectal peritoneal metastases: the impact of emerging treatment options

The thesis discusses various treatment options for patients with peritoneal metastases from colorectal cancer. Chapter 1 covers the impact of the PRODIGE 7 study, which examined the effectiveness of CRS-HIPEC, suggesting HIPEC may be less effective and causing shifts in clinical practices, such as reduced use of oxaliplatin. Chapter 2 focuses on the CRC-PIPAC-II study, investigating the safety and effectiveness of combining systemic therapy with ePIPAC-OX. This bidirectional therapy was found feasible with promising survival outcomes. Chapter 3 discusses combining CRS-HIPEC with intraoperative radiotherapy (IORT) for patients with locally advanced or recurrent rectal cancer, showing it to be a feasible treatment option. Chapter 4 shows that palliative tumor resection is associated with better survival outcomes than systemic therapy alone. Chapter 5 introduces the INTERACT II study, which explores intraperitoneal irinotecan, potentially improving survival. Chapter 6 examines patient-reported outcomes in CRC-PIPAC-II, indicating the treatment was generally well-tolerated. Chapter 7 compares pain outcomes after ePIPAC-OX monotherapy and conventional surgery, concluding that PIPAC-OX causes more postoperative pain. Chapter 8 compares patient-reported outcomes between CRS-HIPEC and standard surgery, finding no significant difference in long-term outcomes.