ASO Author Reflections: Molecular Profiling Can Provide Personalized Clinical Guidance in the Management of Peritoneal Malignancies

Excerpt

Management guidelines for peritoneal dissemination of appendiceal and other gastrointestinal malignancies are limited by the paucity of strong evidence from robustly designed randomized clinical trials.1 Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a treatment approach considered increasingly at centers with experience. The criteria for selection of patients who would benefit from this aggressive surgical intervention are based on consideration of clinicopathologic factors such as tumor grade and histologic subtype, surgeons’ experience, and patients’ general surgical candidacy. The heterogeneity of outcomes, however, reflects the limitations of conventional decision-making approaches. This decision-making is even more challenging when complete cytoreduction is unlikely or not feasible. Nevertheless, CRS/HIPEC still may be offered to select patients because the retrospective evidence supports long-term survival for a reasonable number of patients. …