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Background and purpose Women with colorectal cancer (CRC) are at risk not only of developing ovarian metastases, but also of developing a primary ovarian malignancy. Several earlier studies have in fact shown a link between the development of primary ovarian cancer and CRC. The purpose of this study was therefore to determine the risk of developing a primary ovarian cancer in women with prior CRC compared to the general population. Methods Data from the Netherlands Cancer Registry were used. All women diagnosed with invasive CRC between 1989 and 2017 were included. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) per 10,000 person-years were calculated. Results During the study period, 410 (0.3%) CRC patients were diagnosed with primary ovarian cancer. Women with CRC had a 20% increased risk of developing ovarian cancer compared to the general population (SIR = 1.2, 95% CI: 1.1-1.3). The AER of ovarian cancer was 0.9 per 10,000 person-years. The risk was especially increased within the first year of a CRC diagnosis (SIR = 3.3, 95% CI: 2.8-3.8) and in women aged

The objective of this study was to assess the incidence, treatment, and survival of patients with synchronous peritoneal metastases (PM) from extraperitoneal primary tumors. A cohort was selected from the Netherlands Cancer Registry (NCR), in which all patients diagnosed with PM in 2017 and 2018 were screened for eligibility. The five most common primary extraperitoneal origins of PM were included for further analyses: lung, breast, urinary tract, and kidney cancer and malignant melanoma. Survival was investigated using log-rank test between different primary tumor locations. In total, 480 patients were diagnosed with synchronous PM from extraperitoneal origins. The proportion of patients with PM per extraperitoneal origin ranged between 0.1 and 1.1%, with the highest proportion in lung cancer patients. Of all patients, 234 (49%) received tumor-directed treatment and 246 (51%) received no tumor-directed treatment. Survival in patients with PM from lung, breast, urinary tract, and kidney cancer and malignant melanoma was 1.6 months, 15.7 months, 5.4 months, 3.4 months, and 2.1 months, respectively (p

This thesis evaluated the role of ovarian metastases in colorectal cancer patients. It particularly researched the rationale behind the need for increased awareness among physicians regarding the presence or development of ovarian malignancies in colorectal cancer patients. The relevance of this thesis is addressed by several findings. The first one is the fact that ovarian metastases seem to occur more frequently in younger/premenopausal colorectal cancer patients as compared to older patients. Secondly, in a highly selected patient population ovarian metastases are not as harmful as previously expected. Furthermore, the ovaries are generally considered unresponsive to systemic therapy, which is unfortunately still poorly understood. Cytoreductive surgery (operative removal of tumors) followed by hyperthermic intraperitoneal chemotherapy (HIPEC, warm chemotherapy circulating in the peritoneum) showed better overall survival in colorectal cancer patients with ovarian metastases compared with surgery alone. Another finding is that there is a higher incidence of (primary) ovarian cancer in colorectal cancer patients compared to the general population. Lastly, oncologic outcomes may improve following a prophylactic salpingo-oophorectomy in colorectal cancer patients.

This thesis provided an overview of the incidence, treatment, and prognosis of colorectal peritoneal metastases and focused on the potential role of treatment with PIPAC in the palliative setting. PIPAC is a new method of administering chemotherapy into the abdomen as a pressurized aerosol, with potential advantages over systemic chemotherapy. Despite the worldwide growing popularity of PIPAC, there is no scientific evidence that confirms the superiority or non-inferiority of PIPAC over systemic chemotherapy. Hence, two studies were initiated in the Netherlands to gain more insight into the side effects and tolerability, anti-tumour efficacy, and costs of treatment with PIPAC, and quality of life during treatment with PIPAC. The first study (CRC-PIPAC) focused on repetitive treatment with PIPAC every 4-6 weeks without systemic chemotherapy in between, the results of which are reported in this thesis. The second study (CRC-PIPAC-II) focused on repetitive PIPAC alternated with systemic chemotherapy, the results of which are expected over the course of 2022.