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. 2023 Mar;127(3):442-449.
doi: 10.1002/jso.27136. Epub 2022 Nov 9.

A total neoadjuvant chemotherapy approach is associated with improved recurrence-free survival in patients with colorectal peritoneal metastases undergoing cytoreductive surgery and HIPEC

David N Hanna  1 , Rebekah Macfie  2 , Muhammad O Ghani  1 , Andrew Hermina  1 , Alexander Mina  3 , Da Eun Cha  2 , Christina E Bailey  1 , Noah Cohen  2 , Daniel Labow  2 , Benjamin Golas  2 , Umut Sarpel  2 , Deepa Magge  1 , Kamran Idrees  1
Affiliations

A total neoadjuvant chemotherapy approach is associated with improved recurrence-free survival in patients with colorectal peritoneal metastases undergoing cytoreductive surgery and HIPEC

David N Hanna et al. J Surg Oncol. 2023 Mar.

Abstract

Background: The primary aim of this study is to evaluate the oncologic outcomes of two popular systemic chemotherapy approaches in patients with colorectal peritoneal metastases (CPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Methods: We performed a dual-center retrospective review of consecutive patients who underwent CRS-HIPEC for CPM due to high or intermediate-grade colorectal cancer. Patients in the total neoadjuvant therapy (TNT) group received 6 months of preoperative chemotherapy. Patients in the "sandwich" (SAND) chemotherapy group received 3 months of preoperative chemotherapy with a maximum of 3 months of postoperative chemotherapy.

Results: A total of 34 (43%) patients were included in the TNT group and 45 (57%) patients in the SAND group. The median overall survival (OS) in the TNT and SAND groups were 77 and 61 months, respectively (p = 0.8). Patients in the TNT group had significantly longer recurrence-free survival (RFS) than the SAND group (29 vs. 12 months, p = 0.02). In a multivariable analysis, the TNT approach was independently associated with improved RFS.

Conclusion: In this retrospective study, a TNT approach was associated with improved RFS, but not OS when compared with a SAND approach. Further prospective studies are needed to examine these systemic chemotherapeutic approaches in patients with CPM undergoing CRS-HIPEC.

Keywords: CRS-HIPEC; colorectal cancer; outcomes; peritoneal carcinomatosis; systemic chemotherapy.

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Figures

Figure 1.
Figure 1.
(A) Overall survival and (B) recurrence-free survival for patients with CPM undergoing CRS-HIPEC based on systemic chemotherapy approach
Figure 2.
Figure 2.
Subgroup analysis demonstrating (A) Overall survival and (B) recurrence-free survival for patients with CPM undergoing CRS-HIPEC who underwent sandwich chemotherapy approach
See this image and copyright information in PMC

References

    1. Colon Cancer. 2019; https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed 03/02/2022, 2022.
    1. Franko J, Shi Q, Meyers JP, et al. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol. 2016;17(12):1709–1719. - PubMed
    1. Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11(5):518–521. - PubMed
    1. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27(5):681–685. - PubMed
    1. Franko J, Ibrahim Z, Gusani NJ, Holtzman MP, Bartlett DL, Zeh HJ 3rd. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756–3762. - PubMed

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