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Multicenter Study
. 2024 May 8;8(3):zrae017.
doi: 10.1093/bjsopen/zrae017.

Hyperthermic intraperitoneal chemotherapy in colorectal cancer

Oliver M Fisher  1   2   3 , Chris Brown  4 , Jesus Esquivel  5 , Stein G Larsen  6 , Winston Liauw  2   7 , Nayef A Alzahrani  1   8 , David L Morris  1 , Vahan Kepenekian  9   10 , Isabelle Sourrouille  11 , Frédéric Dumont  12 , Jean-Jacques Tuech  13 , Cécilia Ceribelli  14 , Béranger Doussot  15 , Olivia Sgarbura  16   17 , Mohammed Alhosni  18 , Francois Quenet  17 , Olivier Glehen  9   10 , Peter H Cashin  19   20 ; Peritoneal Surface Oncology Group International (PSOGI), Nordic Peritoneal Oncology Group (NPOG), American Society for Peritoneal Surface Malignancy (ASPSM) and BIG-RENAPE Groups
Collaborators, Affiliations
Multicenter Study

Hyperthermic intraperitoneal chemotherapy in colorectal cancer

Oliver M Fisher et al. BJS Open. .

Abstract

Background: This study evaluated the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in colorectal cancer with peritoneal metastases (pmCRC) in a large international data set of patients.

Patients and methods: Patients with pmCRC from 39 centres who underwent cytoreductive surgery with HIPEC between 1991 and 2018 were selected and compared for the HIPEC protocols received-oxaliplatin-HIPEC versus mitomycin-HIPEC. Following analysis of crude data, propensity-score matching (PSM) and Cox-proportional hazard modelling were performed. Outcomes of interest were overall survival (OS), recurrence-free survival (RFS) and the HIPEC dose-response effects (high versus low dose, dose intensification and double drug protocols) on OS, RFS and 90-day morbidity. Furthermore, the impact of the treatment time period was assessed.

Results: Of 2760 patients, 2093 patients were included. Median OS was 43 months (95% c.i. 41 to 46 months) with a median RFS of 12 months (95% c.i. 12 to 13 months). The oxaliplatin-HIPEC group had an OS of 47 months (95% c.i. 42 to 53 months) versus 39 months (95% c.i. 36 to 43 months) in the mitomycin-HIPEC group (P = 0.002), aHR 0.77, 95% c.i. 0.67 to 0.90, P < 0.001. The OS benefit persisted after PSM of the oxaliplatin-HIPEC group and mitomycin-HIPEC group (48 months (95% c.i. 42 to 59 months) versus 40 months (95% c.i. 37 to 44 months)), P < 0.001, aHR 0.78 (95% c.i. 0.65 to 0.94), P = 0.009. Similarly, matched RFS was significantly higher for oxaliplatin-HIPEC versus others (13 months (95% c.i. 12 to 15 months) versus 11 months (95% c.i. 10 to 12 months, P = 0.02)). High-dose mitomycin-HIPEC protocols had similar OS compared to oxaliplatin-HIPEC. HIPEC dose intensification within each protocol resulted in improved survival. Oxaliplatin + irinotecan-HIPEC resulted in the most improved OS (61 months (95% c.i. 51 to 101 months)). Ninety-day mortality in both crude and PSM analysis was worse for mitomycin-HIPEC. There was no change in treatment effect depending on the analysed time period.

Conclusions: Oxaliplatin-based HIPEC provided better outcomes compared to mitomycin-based HIPEC. High-dose mitomycin-HIPEC was similar to oxaliplatin-HIPEC. The 90-day mortality difference favours the oxaliplatin-HIPEC group. A trend for dose-response between low- and high-dose HIPEC was reported.

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Figures

Fig. 1
Fig. 1
Flowchart of patient data selection and analysis
Fig. 2
Fig. 2
a Crude overall survival stratified by MMC- or Ox-HIPEC. b Crude recurrence-free survival stratified by MMC- or Ox-HIPEC
Fig. 3
Fig. 3
a Matched overall survival stratified by MMC- or Ox-HIPEC. b Matched recurrence-free survival stratified by MMC- or Ox-HIPEC
Fig. 4
Fig. 4
Impact of varying MMC- and Ox-HIPEC protocols on overall survival and recurrence-free survival (continued on next page)
Fig. 4
Fig. 4
Impact of varying MMC- and Ox-HIPEC protocols on overall survival and recurrence-free survival (continued on next page)
Fig. 4
Fig. 4
Impact of varying MMC- and Ox-HIPEC protocols on overall survival and recurrence-free survival (continued on next page)
See this image and copyright information in PMC

References

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