Liquid Biopsy in Peritoneal Carcinomatosis from Colorectal Cancer: Current Evidence and Future Perspectives

Abstract

Peritoneal carcinomatosis from colorectal cancer (PC-CRC) is a challenging condition associated with poor outcomes, even with aggressive treatments like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). One of the main challenges is the lack of reliable biomarkers to guide personalized treatment decisions. Circulating tumor DNA (ctDNA) in plasma has recently emerged as a promising tool in colorectal cancer (CRC) management. It detects residual disease after surgery in early-stage CRC and tracks mutations, treatment response, and resistance in metastatic CRC (mCRC). For PC-CRC, ctDNA, along with peritoneal tumor DNA (ptDNA) detected in peritoneal fluid, could offer significant insights for guiding treatment. These biomarkers have potential to improve disease monitoring and outcomes in this challenging context. This review examines the strengths, limitations, and future applications of liquid biopsy for PC-CRC care.