Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis

Abstract

BACKGROUND:Survival benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion was demonstrated by a prospective randomized trial for colorectal peritoneal carcinomatosis. Because of a recent substantial improvement in chemotherapy, the authors analyzed treatment options of colorectal carcinomatosis in the current era.METHODS:Consecutive patients with colorectal carcinomatosis treated by cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion from 2001 to 2007 were included. The control group patients with carcinomatosis received contemporary chemotherapy alone. Overall survival was the primary endpoint.RESULTS:All patients underwent systemic chemotherapy. The cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion group (n = 67) was similar to the control group (n = 38) in sex, tumor grade, site of tumor origin, T status, and N status. The control group was, however, older (59 vs 51 years; P<.001). Median survival measured from the diagnosis of peritoneal disease was longer with cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion (34.7 months vs 16.8 months; P<.001). Presence of liver metastasis was a significant negative predictor of survival (hazard ratio, 2.13).CONCLUSIONS:The authors concluded that 1) contemporary chemotherapy is associated with prolonged survival among patients with carcinomatosis as compared with historical controls, and 2) addition of cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion to modern chemotherapy regimens may significantly prolong survival. Cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion and systemic chemotherapy are not competitive therapies, and they both have a role in a multidisciplinary approach to patients with carcinomatosis. Cancer 2010. © 2010 American Cancer Society.

Cytoreductive surgery and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: Prognosis and treatment of recurrences in a cohort study

“…[1][2][3][4][5][6] Concerning comparative studies, the method mainly investigated is intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) revealing significant improvement over systemic chemotherapy alone in one randomised and two case control trials. [1][2][3] Early postoperative intraperitoneal chemotherapy (EPIC) and sequential postoperative intraperitoneal chemotherapy (SPIC) have also been investigated against systemic chemotherapy. [4][5][6] There are three multi-institutional observational IPC studies published: two French studies with 506 and 523 patients and one Italian study with 146 patients.…”

Multimodality treatment strategies have changed prognosis of peritoneal metastases

“…Global survival in the CRSHIPEC group (2 years: 81%, 5 years: 51%) was significantly (P < 0.05) improved compared to the systemic chemotherapy (2 years: 65%, 5 years: 13%). Franko et al [45] (2010)…”

“…Peritoneal metastases multimodality treatment strategies Figure 4 Kaplan-Meier survival curve comparing hyperthermic intraperitoneal chemotherapy to standard treatment, for colorectal peritoneal carcinomatosis [35] (with permission) (A) and comparing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment to systemic chemotherapy alone, for colorectal peritoneal carcinomatosis [45] (with permission) (B). A: Kaplan-Meier survival curve comparing HIPEC to standard treatment, for Colorectal PM [35] : Available from: URL: http://click.info.…”

“…A: Kaplan-Meier survival curve comparing HIPEC to standard treatment, for Colorectal PM [35] : Available from: URL: http://click.info. copyright.com/ ?qs=2b7046b10dd0c5471bbbb8bac0096e00e895f442c0326423c 4ec2ccdd7b4701b99fd4bd5b32f0283; B: Kaplan-Meier survival curves comparing CRS-HIPEC treatment to systemic chemotherapy alone, for Colorectal PM [45] : Available from: URL: http://click.info.copyright.com/ ?qs=2b7046b10dd0c5471bb bb8bac0096e00e895f442c03264235cab52a23497a2d7e22ca0949c16bf1f. CRS-HIPEC: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy; PM: Peritoneal metastases.…”

Abdominal Advanced Oncologic Surgery

“…During the last decade a randomized study , two multicentric comparative studies and a numbers of observational studies have tested the CRS and HIPEC activity against PC from CRC with encouraging results: mortality and postoperative morbidity of 0-8% and 39-72% respectively and 5 years survival of 40-51% (Verwaal et al, 2003(Verwaal et al, , 2005Elias et al, 2009Elias et al, , 2006Franko et al, 2010). Main indications for application of the procedure are the presence of PC both synchronous or metachronous , therefore defining it a therapeutic procedure.…”