Oncology Frontier: Isolated peritoneal carcinomatosis related to colorectal cancer occurs infrequently and is associated with a poor prognosis. In response to these challenges， investigators have attempted to treat patients using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) or EPIC (early postoperative intraperitoneal cavity chemotherapy). What do you think of the role and status of EPIC or HIPC in colorectal cancer patients with peritoneal metastasis after undergoing cytoreductive surgery?

　　《肿瘤瞭望》：结直肠癌的孤立的腹膜转移并不常见，伴有孤立的腹膜转移的患者预后很差，为了迎接这个挑战，研究者们试图对伴有孤立腹膜转移的结直肠癌患者进行减瘤术并术后进行腹膜内高温热灌注治疗（HIPEC）或早期术后腹膜腔内化疗（EPIC）。您认为HIPEC或EPIC在具有孤立的腹膜转移的结直肠癌患者接受减瘤术后的治疗中的作用和地位如何？

　　Dr Ryan: We are starting to view this similarly to those patients with isolated liver or lung metastases. In other words， we think that a subset of patients who have isolated peritoneal disease may be cured where it can be completely resected. It remains an open question whether these patients benefit from HIPEC or EPIC. That question is open to debate and the Prodige 7 study will hopefully answer that question because everybody in the study receives cytoreductive surgery and then patients were randomized to either receive intraperitoneal chemotherapy or not.

　　Dr Ryan：我们也像关注肝转移或者肺转移一样，开始关注结直肠癌患者的腹膜转移。换句话说，我们认为相当一部分的具有孤立腹膜转移结节的患者可以完整地切除结节并得到治愈。而这些患者能不能从HIPEC或者EPIC获益仍然是大家讨论的热点。Prodige 7研究将有望回答这个问题，因为在这个研究中的每例患者都接受减瘤手术，然后被随机分到接受腹腔内化疗组或者不接受腹腔内化疗组。

　　Oncology Frontier: Stringent patient selection is also critical to optimizing operative and oncologic outcomes of patients undergoing CRS/HIPEC. What kinds of patients can be selected to undergo HIPEC or EPIC treatment?

　　《肿瘤瞭望》：腹膜转移的结直肠癌患者接受减瘤术后需进行严格筛选进行后续的HIPEC或EPIC治疗，在临床工作中，您认为哪些患者可以进行HIPEC或EPIC治疗?

　　Dr Ryan: Right now， many of the surgeons who do this type of surgery， consider it a package program. In other words， if you are going to do cytoreductive surgery， it is followed by intraperitoneal chemotherapy. It is then a local or institutional preference whether it is HIPEC or EPIC.

　　Dr Ryan：现在，很多选择做这个手术的外科医生都将它视作一个治疗整体。换句话说，如果进行减瘤手术，之后都会进行腹腔内化疗。而选择HIPEC或者EPIC这主要取决于当地或者医疗机构的偏好。

　　Oncology Frontier: Several clinical trials indicated that compared with the postoperative observation group， patients who underwent preoperative neoadjuvant chemoradiation therapy do not get benefit from receiving fluorouracil-based adjuvant chemotherapy. What do you think is the reason recent adjuvant chemotherapy clinical trials have been consistently negative?

　　《肿瘤瞭望》：在多个临床实验中均证实，术前接受新辅助放化疗的直肠癌患者术后接受以氟尿嘧啶为基础的辅助化疗，与术后观察组相比，并没有明显的获益。您认为有关术后辅助化疗的近期临床试验失败的原因是什么？

　　Dr Ryan: I don’t think they are consistently negative. These are retrospective series of patients who have a wide array of competing mortality risks in terms of what line of chemotherapy they have had and whether they are sensitive or not to chemotherapy. So I think we need more randomized controlled studies to help guide us in terms of how much intraperitoneal chemotherapy is necessary， whether intraperitoneal chemotherapy is necessary and whether we need to heat that intraperitoneal chemotherapy. My experience in the United States is that almost all of the patients I see who subsequently go on to get cytoreductive surgery， the surgeons are insisting that patients get preoperative chemotherapy with either FOLFOX-based chemotherapy or FOLFIRI-based chemotherapy.

　　Dr Ryan：我认为它们不都是阴性结果。有很多回顾性研究表明，患者的死亡风险随着他们所接受的化疗方案及他们对化疗的敏感程度的不同而不同。所以我认为需要更多的随机对照研究来帮助我们解决是否需要腹腔内化疗，进行次数，以及是否需要加热这些问题。根据我在美国的经验，我观察到的大部分接受了减瘤手术的患者，他们的外科医师都坚持让他们接受术前基于FOLFOX或者FOLFIRI的化疗方案。

　　Oncology Frontier: What has been the take home message from ASCO 2015 for you?

　　《肿瘤瞭望》：您参加本届ASCO年会的收获有哪些？

　　Dr Ryan: The take home message for patients with peritoneal carcinomatosis is that cytoreductive surgery may actually cure a subset of patients， and it is more likely to be curative where the patient is rendered free of all disease at the time of surgery. It remains an open question how beneficial any intraperitoneal chemotherapy is postoperatively. Thankfully， the study that will answer that， the Prodige 7 study from France， has completed accrual and those results should be reported in 2-3 years.

　　Dr Ryan：对于那些腹膜转移的患者，减瘤手术确实可以治愈一部分患者，尤其是在手术时不患有其他疾病的患者。术后腹腔内化疗是否获益仍然是一个讨论热点。幸运的是，来自法国的Prodige 7研究将回答这个问题，该研究已完成入组，且会在2-3年后得到结果。