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. 2021 Apr;12(2):516-526.
doi: 10.21037/jgo-20-494.

Oxaliplatin-based hyperthermic intraperitoneal chemotherapy with single drug versus multiple drug treatment for colorectal cancer with peritoneal metastases: an observational cohort study

Petter Frühling  1 , Lana Ghanipour  1 , Paul Dranichnikov  1 , Malin Enblad  1 , Helgi Birgisson  1 , Peter H Cashin  1
Affiliations

Oxaliplatin-based hyperthermic intraperitoneal chemotherapy with single drug versus multiple drug treatment for colorectal cancer with peritoneal metastases: an observational cohort study

Petter Frühling et al. J Gastrointest Oncol. 2021 Apr.

Abstract

Background: Long-term survival for selected patients with peritoneal metastases (PM) from colorectal cancer (CRC) is possible when treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The objective of this study was to compare three different oxaliplatin-based (OX)-HIPEC regimens. Primary end-point was disease-free survival (DFS), and secondary endpoints, morbidity and overall survival (OS).

Methods: This is a retrospective study of all patients with colorectal PM treated with CRS and HIPEC between 2004 and 2015 from the prospectively maintained Uppsala HIPEC database. One hundred and thirty-three patients were identified. Three HIPEC regimens were included: OX-HIPEC, OX-HIPEC + post-operative intraperitoneal chemotherapy (EPIC) with 5-fluorouracil (5-FU), and oxaliplatin-irinotecan-based (OXIRI)-HIPEC. Multivariable Cox regression for DFS was performed.

Results: Sixty-one patients received OX-HIPEC, 24 patients received OX-HIPEC + 5-FU EPIC, and 48 patients received OXIRI-HIPEC. The DFS for the OX-HIPEC group was 10.5 months, OX-HIPEC + EPIC 11.9 months, and OXIRI-HIPEC 13.4 months (OX-HIPEC vs. OXIRI HIPEC, P=0.049). The morbidity and OS did not differ between the groups. In the multivariable analysis, low peritoneal cancer index (PCI), absence of liver metastases, low completeness of cytoreduction (CC) score, and multiple drug (EPIC or OXIRI) HIPEC regimen were independent prognostic factors for DFS.

Conclusions: This study showed improved DFS with an intensification of HIPEC by adding irinotecan or EPIC compared to oxaliplatin alone without an increase in morbidity or mortality.

Keywords: Colorectal cancer (CRC); cytoreductive surgery (CRS); hyperthermic intraperitoneal chemotherapy (HIPEC); oxaliplatin; peritoneal metastases (PM).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jgo-20-494). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of patients with CRC and PM (n=133). CRC, colorectal cancer; PM, peritoneal metastases; HIPEC, hyperthermic intraperitoneal chemotherapy; OX-HIPEC, oxaliplatin-based HIPEC; EPIC, post-operative intraperitoneal chemotherapy; OXIRI-HIPEC, oxaliplatin-irinotecan-based HIPEC.
Figure 2
Figure 2
Description of which HIPEC regimen, that was used during the study period 2004–2015. HIPEC, hyperthermic intraperitoneal chemotherapy; OX-HIPEC, oxaliplatin-based HIPEC; EPIC, post-operative intraperitoneal chemotherapy; OXIRI-HIPEC, oxaliplatin-irinotecan-based HIPEC.
Figure 3
Figure 3
DFS between the three HIPEC regimens. OX-HIPEC vs. OX-HIPEC + EPIC P=0.33, OX-HIPEC vs. OXIRI-HIPEC P=0.049 (total n=133). DFS, disease-free survival; HIPEC, hyperthermic intraperitoneal chemotherapy; OX-HIPEC, oxaliplatin-based HIPEC; EPIC, post-operative intraperitoneal chemotherapy; OXIRI-HIPEC, oxaliplatin-irinotecan-based HIPEC.
Figure 4
Figure 4
DFS between the three HIPEC regimens, excluding CC1–3 and liver metastases. OX-HIPEC vs. OX-HIPEC + EPIC P=0.029, OX-HIPEC vs. OXIRI-HIPEC P=0.017 (total n=101). DFS, disease-free survival; HIPEC, hyperthermic intraperitoneal chemotherapy; CC, completeness of cytoreduction; OX-HIPEC, oxaliplatin-based HIPEC; EPIC, post-operative intraperitoneal chemotherapy; OXIRI-HIPEC, oxaliplatin-irinotecan-based HIPEC.
Figure 5
Figure 5
OS between the three HIPEC regimens. OX-HIPEC vs. OX-HIPEC + EPIC P=0.9, OX-HIPEC vs. OXIRI-HIPEC P=0.16 (total n=133). OS, overall survival; HIPEC, hyperthermic intraperitoneal chemotherapy; OX-HIPEC, oxaliplatin-based HIPEC; EPIC, post-operative intraperitoneal chemotherapy; OXIRI-HIPEC, oxaliplatin-irinotecan-based HIPEC.
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References

    1. Jayne DG, Fook S, Loi C, et al. Peritoneal carcinomatosis from colorectal cancer. Br J Surg 2002;89:1545-50. 10.1046/j.1365-2168.2002.02274.x - DOI - PubMed
    1. Esquivel J, Elias D, Baratti D, et al. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol 2008;98:263-7. 10.1002/jso.21053 - DOI - PubMed
    1. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 2004;22:3284-92. 10.1200/JCO.2004.10.012 - DOI - PubMed
    1. Shen P, Hawksworth J, Lovato J, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 2004;11:178-86. 10.1245/ASO.2004.05.009 - DOI - PubMed
    1. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 2010;28:63-8. 10.1200/JCO.2009.23.9285 - DOI - PubMed

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