Original Title: Pertinence de la chimiothérapie intrapéritonéale pour prévenir ou traiter les néoplasies des surfaces péritonéales - Métastases péritonéales secondaires à un cancer colorectal

Authors' objectives: In order to promote the judicious use of this intervention and harmonize the care of affected individuals, the Institut national d’excellence en santé et services sociaux (INESSS) has been mandated to issue an opinion on the clinical relevance of intraperitoneal chemotherapy for preventing or treating PSNs. This opinion is expected to specify the modalities of intraperitoneal chemotherapy to be recommended for recognized therapeutic indications, where applicable. This work is divided into five sections relating to the most common types of PSN encountered in clinical practice (peritoneal mesothelioma and peritoneal metastases of colorectal, ovarian, gastric, and appendicular origin). This report focuses on the management of peritoneal metastases secondary to colorectal cancer.

Authors' results and conclusions: RESULTS (#1 HEALTH NEEDS AND HIPEC PRACTICE IN QUEBEC): People with metastatic colorectal cancer that has spread to the peritoneum have a poor prognosis and significantly impaired quality of life (#2 ASSESSMENT OF THE LEVEL OF SCIENTIFIC EVIDENCE): The studies are not very comparable to each other due to heterogeneity in the clinical profile of the study populations, the completeness of information on the characteristics of the treatment groups, surgical procedures and protocols, the HIPEC and systemic adjuvant chemotherapy used and the timing of their administration, and the primary outcome measures (#3 EFFICACY AND SAFETY OF HIPEC - PREVENTIVE CONTEXT IN INDIVIDUALS TREATED FOR COLORECTAL TUMOURS WITH A HIGH RISK OF METACHRONOUS PERITONEAL METASTASES): The administration of mitomycin C-based HIPEC (30 mg/m2 , 60 minutes) in an intraoperative adjuvant setting after primary tumour resection increases locoregional control (absence of relapse in the tumour bed or peritoneal surfaces) compared to primary treatment without HIPEC, without however altering overall survival or disease-free survival. This HIPEC approach does not affect the frequency of serious complications (level of evidence: low. (#3.1 EFFICACY AND SAFETY OF HIPEC - IN A CURATIVE CONTEXT IN PATIENTS TREATED FOR RESECTABLE PERITONEAL METASTASES OF COLORECTAL ORIGIN): The administration of intraoperative oxaliplatin-based HIPEC (360-460 mg/m2, 30 minutes) after complete cytoreduction of peritoneal metastases, in combination with perioperative systemic chemotherapy, does not alter overall survival compared with complete cytoreduction without HIPEC in combination with perioperative systemic chemotherapy, but it increases the frequency of serious complications and the length of hospitalization (level of evidence: low). (#4 PERSPECTIVE IN THE QUEBEC CONTEXT - PREVENTIVE CONTEXT IN INDIVIDUALS TREATED FOR COLORECTAL TUMOURS WITH A HIGH RISK OF METACHRONOUS PERITONEAL METASTASES): Clinicians consider that the available evidence does not support the use of HIPEC in a prophylactic setting during second-look surgery or in an adjuvant setting after primary resection (#4.1 CURATIVE CONTEXT IN PEOPLE TREATED FOR RESECTABLE PERITONEAL METASTASES OF COLORECTAL ORIGIN): Oxaliplatin-based HIPEC (PRODIGE 7 protocol) is not used in Quebec.

Authors' recommendations: In individuals treated for colorectal cancer with a high risk of developing metachronous peritoneal metastases: • Administration of oxaliplatin-based HIPEC is not recommended: - in an intraoperative or sequential adjuvant setting after primary tumour resection. In patients treated for peritoneal metastases of colorectal origin undergoing complete cytoreductive surgery: • The administration of intraoperative oxaliplatin-based HIPEC is not recommended. In support of this position, INESSS makes some additional recommendations aimed at promoting optimal healthcare provision: • Individuals with colorectal tumours at high risk of developing metachronous peritoneal metastases, as well as those with colorectal peritoneal metastases (resectable or not, with or without extraperitoneal metastases) should be referred as soon as possible to a referral center with a multidisciplinary healthcare team specializing in peritoneal surface neoplasms.

Authors' methods: A comprehensive review of scientific literature and gray literature was conducted to identify scientific information on the clinical relevance of intraperitoneal chemotherapy for the management of colorectal-derived PSNs, both in a preventive and curative context. Information on population and sociocultural considerations surrounding the practice of the intervention was also extracted. The literature selected includes randomized clinical trials (7 publications from 5 studies) as well as international recommendations from health technology evaluation reports, clinical practice guidelines, and publications from expert groups (13 publications from 10 organizations).

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-de-la-chimiotherapie-intraperitoneale-pour-prevenir-ou-traiter-les-neoplasies-des-surfaces-peritoneales.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)