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Review
. 2025 Jul;14(14):e71043.
doi: 10.1002/cam4.71043.

Executive Summary of the American Radium Society Appropriate Use Criteria for the Management of Peritoneal Carcinomatosis From Different Tumor Origins: Systematic Review and Guidelines

Expert Panel Management of Peritoneal Carcinomatosis; Timothy Kennedy  1 , Sareena Singh  2 , Gerard Abood  3 , Eric Christenson  4 , Christopher J Anker  5 , Dmitriy Akselrod  6 , Christopher L Hallemeier  7 , Krishan R Jethwa  7 , Ed Kim  8 , Percy Lee  9 , Eric D Miller  10 , Neil B Newman  11 , J Eva Selfridge  12 , Navesh Sharma  13 , William Small Jr  14 , Leila Tchelebi  15 , Vonetta M Williams  16 , Suzanne Russo  17
Affiliations
Review

Executive Summary of the American Radium Society Appropriate Use Criteria for the Management of Peritoneal Carcinomatosis From Different Tumor Origins: Systematic Review and Guidelines

Expert Panel Management of Peritoneal Carcinomatosis et al. Cancer Med. 2025 Jul.

Abstract

Background: Multimodality therapy incorporating a combination of cytoreductive surgery (CRS), intraperitoneal (IP) and systemic therapy continues to evolve for peritoneal carcinomatosis (PC) However, treatment and outcomes vary depending on tumor of origin.

Aims: To develop Appropriate Use Criteria (AUC) guidelines to facilitate treatment decision-making for patients with PC based on available evidence.

Materials and methods: The American Radium Society (ARS) multidisciplinary expert panel performed a comprehensive systematic review. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology was used. These studies were used to inform the expert panel, which then rated the appropriateness of various treatments in seven representative clinical scenarios through a well-established modified Delphi consensus methodology.

Results: Treatment of PC is often treated with a combination of CRS and IP ± systemic chemotherapy but specific recommendations exist for different tumor types and outcomes vary.

Discussion: Treatment of PC is complex and varies depending on origin of primary tumor and extent of disease. These AUC assist in patient and treatment selection for different clinical scenarios.

Conclusion: A summary of recommendations is outlined to guide practitioners on the management of PC from different tumor origins.

Keywords: cytoreductive surgery; early postoperative intraperitoneal chemotherapy (EPIC); hyperthermic intraperitoneal chemotherapy (HIPEC); intraperitoneal; peritoneal carcinomatosis; pressurized intraperitoneal aerosolized chemotherapy (PIPAC).

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Conflict of interest statement

All panelists were required to declare all conflicts of interest for the previous 36 months prior to initiating work on this document. These complete disclosure forms are retained by the ARS in perpetuity. The ARS AUC Steering Committee reviewed these disclosures with the chair and co‐chair of this document and approved the participation of the panelists prior to starting the development of this work. Disclosures potentially relevant to the content of this guideline are provided: 4Dr. Christensen reports grants from Haystack Oncology, Pfizer Inc., Affimed gmbh, and Nextcure; and consulting fees from Seres Therapeutics, SIRTEX. 6Dr. Akselrod reports consulting fees from Otsuka America Pharmaceutical. 7Dr. Jethwa reports honoraria from RadOncQuestions.com LLC. 9Dr. Lee reports honoraria from Varian, ViewRay, AstraZeneca; consulting fees from Varian, ViewRay, AstraZeneca, Genentech, Johnson & Johnson, Roche, RTOG foundation, and meeting and travel support from Radiosurgery Society. 12Dr. Selfridge reports drug support for clinical trials from Medpacto Inc. and Clinigen Inc. and industry‐sponsored studies from BioAtla, Arcus Biosciences, AVEO, Cue Biopharma, and Pfizer. 14Dr. Small reports personal fees from Carl Zeissand meeting and travel support for ACR, NRG Oncology, and Carl Zeiss.

Figures

FIGURE 1
FIGURE 1
PRISMA 2020 [12, 13] study selection flow diagram for management of peritoneal carcinomatosis from different tumor origins.
See this image and copyright information in PMC

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