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Advances in Locoregional Therapies for Gastrointestinal Cancer Metastases

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 15 November 2026 | Viewed by 1669

Special Issue Editor


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Guest Editor
Peritoneal Surface Malignancy Program, Division of Surgical Oncology, Department of Surgery, The University of Kansas Health System, Kansas City, MO 66160, USA
Interests: oncologic surgery; gastrointestinal cancers; peritoneal surface malignancies; cytoreductive surgery; heated intraperitoneal chemotherapy
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Special Issue Information

Dear Colleagues,

Paradoxically, as systemic therapy for metastatic gastrointestinal adenocarcinomas continues to significantly improve both in relation to safety and efficacy, the need for aggressive locoregional treatment for metastases has also risen. Despite this contradiction, from a basic and translation science perspective, it is vital to address these “escape” metastases, which, for a given patient, would have resisted traditional and novel more targeted systemic therapies. Fortunately, in the last decade, due to advances in interventional radiology, endoscopy, and radiation therapy, many different modality options have come to the forefront that do not involve invasive operations. However, aggressive and extensive surgical interventions are still often needed. Thankfully, with modern healthcare and our much-improved capabilities to rescue patients from major complications, even these more invasive options have evolved to become less morbid with low mortality rates. In this Special Issue, we hope to explore the rapidly evolving topic of locoregional therapies for metastases from gastrointestinal cancers.

Prof. Dr. Mazin Al-Kasspooles
Guest Editor

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Keywords

  • gastrointestinal cancer metastases
  • locoregional therapies
  • interventional radiology
  • endoscopy
  • radiation therapy
  • invasive operations
  • cytoreductive surgery (CRS)
  • intraperitoneal chemotherapy (IP)
  • heated intraperitoneal chemotherapy (HIPEC)
  • tumor debulking
  • stereotactic body radiation therapy (SBRT)
  • selective internal radiation therapy (SIRT)

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Published Papers (2 papers)

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Research

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10 pages, 607 KB  
Article
Predictors of Peritoneal Surface Recurrence and Quantitative Association with Time to Relapse After Complete CRS/HIPEC for Colorectal Peritoneal Metastasis
by Corey A. Hounschell, Aubrey C. Swilling, Sahaam Mirza, Katelyn Sanner-Dixon, Jill Haley, Luke V. Selby, Shahid Umar and Mazin Al-Kasspooles
Cancers 2026, 18(2), 299; https://doi.org/10.3390/cancers18020299 - 19 Jan 2026
Viewed by 758
Abstract
Background/Objectives: Peritoneal surface metastases (PSMs) from colorectal cancer have high rates of peritoneal recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prior studies dichotomize peritoneal recurrence into “early” and “late,” limiting insight into how clinicopathologic factors influence recurrence timing. This study [...] Read more.
Background/Objectives: Peritoneal surface metastases (PSMs) from colorectal cancer have high rates of peritoneal recurrence after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Prior studies dichotomize peritoneal recurrence into “early” and “late,” limiting insight into how clinicopathologic factors influence recurrence timing. This study aimed to identify predictors of peritoneal recurrence and quantify their continuous association with time to recurrence following CRS/HIPEC. Methods: Patients undergoing CC-0 CRS/HIPEC for colorectal PSM from 2018 to 2024 were identified from a prospectively maintained database. The primary outcome was peritoneal surface recurrence. Variables included peritoneal cancer index (PCI), tumor location, histology, HIPEC regimen, and KRAS/BRAF/SMAD4 status. Factors with p < 0.10 on univariable analysis were entered into multivariable logistic regression (recurrence: yes/no) and linear regression (time to recurrence). Results: Among 133 patients, 64 (48.1%) developed peritoneal recurrence. Median time to recurrence was 41.4 weeks (IQR 24.9–74.0), and PCI was higher among those who recurred (median 11.0 vs. 5.0, p < 0.01). Neither tumor stage, histology, intraperitoneal chemotherapy agent, nor molecular alterations were associated with increased risk of peritoneal recurrence. When controlling for PCI, right- and sigmoid-colon primaries independently predicted peritoneal recurrence compared to all other locations without influence on recurrence timing (right: OR 7.18; sigmoid: OR 6.54; p < 0.01). Among patients who recurred, each one-point increase in PCI corresponded to a 2.43-week earlier relapse (p < 0.01). Conclusions: Nearly half of patients with colorectal PSM recurred despite complete CRS/HIPEC. Tumor location predicted peritoneal recurrence, while PCI independently shortened time to relapse. Modeling PCI as a continuous predictor refines postoperative risk stratification and may inform individualized surveillance strategies. Full article
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Review

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16 pages, 295 KB  
Review
Regional Therapies Utilized in Treating Unresectable Colorectal Adenocarcinoma with Peritoneal Metastases
by Shray Malik, Vanessa Le, Farshid Dayyani, Maheswari Senthil, Oliver S. Eng and Michael P. O’Leary
Cancers 2026, 18(5), 863; https://doi.org/10.3390/cancers18050863 - 7 Mar 2026
Viewed by 522
Abstract
Colorectal peritoneal metastases portend a poor prognosis when compared to other isolated sites of metastatic disease. The advent of regional therapies, including cytoreductive surgery, have improved outcomes for patients with peritoneal carcinomatosis. However, these options are typically only available in patients deemed to [...] Read more.
Colorectal peritoneal metastases portend a poor prognosis when compared to other isolated sites of metastatic disease. The advent of regional therapies, including cytoreductive surgery, have improved outcomes for patients with peritoneal carcinomatosis. However, these options are typically only available in patients deemed to have resectable disease. For patients with unresectable peritoneal disease, non-surgical regional therapy has only been studied in early-phase clinical trials. This represents a gap in therapy in a population with a desperate need. In this review, we highlight the current limited data, as well as postulate on the future direction of regional therapies in patients with unresectable peritoneal metastases from colorectal adenocarcinoma. Full article
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