Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases

Rovers, Koen P.; Bakkers, Checca; Nienhuijs, Simon W.; Burger, Jacobus W. A.; Creemers, Geert-Jan; Thijs, Anna M.J.; Brandt-Kerkhof, Alexandra R M; Madsen, Eva; Meerten, Esther van; Tuynman, Jurriaan B.; Kusters, Miranda; Versteeg, Kathelijn S.; Aalbers, Arend G. J.; Kok, Niels F. M.; Buffart, Tineke E.; Wiezer, Marinus J.; Boerma, Djamila; Los, Maartje; Reuver, Philip R. de; Bremers, Andreas J A; Verheul, H.; Kruijff, Schelto; Groot, Derk Jan A. de; Witkamp, Arjen J.; Grevenstein, Wilhelmina M U van; Koopman, Miriam; Nederend, Joost; Lahaye, Max J.; Kranenburg, Onno; Fijneman, Remond J.A.; Erve, Iris van ‘t; Snæbjörnsson, Pétur; Hemmer, Patrick H. J.; Dijkgraaf, Marcel G. W.; Punt, Cornelis J.A.; Tanis, Pieter J.; Hingh, Ignace H. J. T. de

doi:10.1001/jamasurg.2021.1642

Cited by 40 publications

(45 citation statements)

References 34 publications

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“…The antivascular endothelial growth factor (VEGF) antibody, bevacizumab, was used (where specifically reported) in 41% (196/480) of patients. 3,12,13,[16][17][18][19] Both the mode and regimen of intraperitoneal chemotherapy varied substantially. Oxaliplatin, mitomycin C, cisplatin, irinotecan, lobaplatin, raltitrexed, and faltitrexed were used in combination or as sole agents as HIPEC.…”

Section: Selected Studiesmentioning

confidence: 99%

“…20 Five studies reported on adjuvant systemic chemotherapy by group (NAC versus SF). 12,13,16,19,21 Of these, 46% (164/356) of patients who received NAC also received adjuvant chemotherapy compared with 58% (258/444) of patients who underwent surgery first. Six studies reported on mean/median PCI 12,13,16,19,22,23 and seven studies reported on the completeness of cytoreduction.…”

Section: Selected Studiesmentioning

confidence: 99%

“…12,13,16,19,21 Of these, 46% (164/356) of patients who received NAC also received adjuvant chemotherapy compared with 58% (258/444) of patients who underwent surgery first. Six studies reported on mean/median PCI 12,13,16,19,22,23 and seven studies reported on the completeness of cytoreduction. 12,13,16,19,[21][22][23] Operative mean/median PCI ranged from 5 to 15 in the NAC group and 6-14.3 in the SF group.…”

Section: Selected Studiesmentioning

confidence: 99%

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The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

et al. 2022

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Background Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is a well-recognised treatment option for the management of colorectal peritoneal metastases (CRPM). However, incorporating the routine use of neoadjuvant chemotherapy (NAC) into this management plan is controversial. Methods A systematic review and meta-analysis were conducted to evaluate the impact of neoadjuvant chemotherapy on perioperative morbidity and mortality, and long-term survival of patients with CRPM undergoing CRS and HIPEC. Results Twelve studies met the inclusion criteria (n = 2,463 patients). Ten were retrospective cohort, one was prospective cohort, and one was a prospective randomised by design. Patients who received NAC followed by CRS and HIPEC experienced no difference in major perioperative morbidity and mortality compared with patients who underwent surgery first (SF). There was no difference in overall survival at 3 years, but at 5 years NAC patients had superior survival (relative risk [RR] 1.31; 95% confidence interval [CI] 1.11–1.54, P < 0.001). There were no differences in 1- and 3-year, disease-free survival (DFS) between groups. Study heterogeneity was generally high across all outcome measures. Conclusions Patients who received neoadjuvant chemotherapy did not experience any increase in perioperative morbidity or mortality. The potential improvement in 5-year overall survival in patients receiving NAC is based on limited confidence due to several limitations in the data, but not sufficiently enough to curtail its use. The practice of NAC in this setting will remain heterogeneous and guided by retrospective evidence until prospective, randomised data are reported.

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Section: Selected Studiesmentioning

confidence: 99%

Section: Selected Studiesmentioning

confidence: 99%

Section: Selected Studiesmentioning

confidence: 99%

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The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

et al. 2022

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“…One trial of note, CAIRO6, seeks to evaluate perioperative systemic chemotherapy and CRS-HIPEC compared to CRS-HIPEC alone in patients with upfront resectable PM. In the Phase II portion of the study, the perioperative chemotherapy regimen appeared safe, although there were similar proportions of macroscopically complete CRS between study arms, perhaps suggesting a lack of benefit of preoperative therapy [ 29 ]. The results of the Phase III portion are eagerly awaited [ 30 ].…”

Section: Future Directionsmentioning

confidence: 99%

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Summary of Key Clinical Trials

Turner

Morris

Sohal

et al. 2022

JCM

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The peritoneal cavity is a common site of metastatic spread from colorectal cancer (CRC). Patients with peritoneal metastases (PM) often have aggressive underlying tumor biology and poor survival. While only a minority of patients with CRC have potentially resectable disease, the high overall incidence of CRC makes management of PM a common clinical problem. In this population, cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemotherapy (HIPEC) is the only effective therapy for appropriately selected patients. In this narrative review, we summarize the existing literature on CRS-HIPEC in colorectal PM. Recent prospective clinical trials have shown conflicting evidence regarding the benefit of HIPEC perfusion in addition to CRS. Current strategies to prevent PM in those at high-risk have been shown to be ineffective. Herein we will provide a framework for clinicians to understand and apply these data to treat this complex disease presentation.

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“…To address this issue in an RCT, the Dutch CAIRO trial [ 59 ] was initiated in 201 and published in 2021. In their randomized phase 2 trial (combined phase 3 trial), 79 patients were randomized to perioperative systemic therapy (experimental arm) or CRS plus HIPEC alone (control arm, open technique with either mitomycin C (35 mg/m 2 , 90 minutes) or oxaliplatin (460 mg/m 2 , 30 minutes) with intravenous leucovorin (20 mg/m 2 , 10 minutes) and 5-FU (400 mg/m 2 , 15 minutes) according to a local protocol.…”

Section: Neoadjuvant Chemotherapy Before Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapymentioning

confidence: 99%

Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer

Kim¹,

Kim

2021

Ann Coloproctol

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From the perspective of survival outcomes, the cancer survival of colorectal cancer (CRC) in the whole stage has improved. Peritoneal metastasis (PM) is found in approximately 8% to 15% of patients with CRC, with a poorer prognosis than that associated with other sites of metastases. Randomized controlled trials and up-to-date meta-analyses provide firm evidence that cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) could significantly improve overall survival compared with systemic chemotherapy alone in selected patients with CRC-PM. Practical guidelines recommend that the management of CRC-PM should be led by a multidisciplinary team carried out in experienced centers and consider CRS plus HIPEC for selected patients. In this review, we aim to provide the latest results of land mark studies and an overview of recent insights with regard to the management of CRC-PM.

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Perioperative Systemic Therapy vs Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Alone for Resectable Colorectal Peritoneal Metastases

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Cited by 40 publications

References 34 publications

The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

The Impact of Neoadjuvant Chemotherapy on the Surgical Management of Colorectal Peritoneal Metastases: A Systematic Review and Meta-Analysis

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Summary of Key Clinical Trials

Treatment for Peritoneal Metastasis of Patients With Colorectal Cancer

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