Long-term survival after hyperthermic intraperitoneal chemotherapy using mitomycin C or oxaliplatin in colorectal cancer patients with synchronous peritoneal metastases: A nationwide comparative study

In the Netherlands, limited variability exists in performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) among centers treating colorectal peritoneal metastases (PM), except for the intraperitoneal drug administration. This offers a unique opportunity to inves...

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Published in:	European journal of surgical oncology 2020-10, Vol.46 (10), p.1902-1907
Main Authors:	Bakkers, C., van Erning, F.N., Rovers, K.P., Nienhuijs, S.W., Burger, J.W., Lemmens, V.E., Aalbers, A.G., Kok, N.F., Boerma, D., Brandt, A.R., Hemmer, P.H., van Grevenstein, W.M., de Reuver, P.R., Tanis, P.J., Tuynman, J.B., de Hingh, I.H.
Format:	Article
Language:	eng
Subjects:	Adenocarcinoma - pathology Adenocarcinoma - secondary Adenocarcinoma - therapy Adenocarcinoma, Mucinous - pathology Adenocarcinoma, Mucinous - secondary Adenocarcinoma, Mucinous - therapy Aged Antineoplastic Agents - therapeutic use Cancer Cancer patients Care and treatment Chemotherapy Colon cancer Colorectal cancer Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Comparative analysis Cytoreduction Surgical Procedures Cytoreductive surgery Female HIPEC Humans Hyperthermic Intraperitoneal Chemotherapy - methods Male Metastasis Middle Aged Mitomycin Mitomycin - therapeutic use Mitomycin C Netherlands Oncology, Experimental Oxaliplatin Oxaliplatin - therapeutic use Patient outcomes Peritoneal metastases Peritoneal Neoplasms - secondary Peritoneal Neoplasms - therapy Proportional Hazards Models Survival Survival Rate Treatment Outcome
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Summary:	In the Netherlands, limited variability exists in performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) among centers treating colorectal peritoneal metastases (PM), except for the intraperitoneal drug administration. This offers a unique opportunity to investigate any disparities in survival between the two most frequently used HIPEC regimens worldwide: mitomycin C (MMC) and oxaliplatin. This was a comparative, population-based cohort study of all Dutch patients diagnosed with synchronous colorectal PM who underwent CRS-HIPEC between 2014 and 2017. They were retrieved from the Netherlands Cancer Registry. Main outcome was overall survival (OS). The effect of the intraperitoneal drug on OS was investigated using multivariable Cox regression analysis. In total, 297 patients treated between 2014 and 2017 were included. Among them, 177 (59.6%) received MMC and 120 (40.4%) received oxaliplatin. Only primary tumor location was different between the two groups: more left-sided colon in the Oxaliplatin group (47.5% vs. 33.3%, respectively, p=0.048). The 1-, 2- and 3-year OS were 84.6% vs. 85.8%, 61.6% vs. 63.9% and 44.7% vs. 53.5% in patients treated with MMC and oxaliplatin, respectively. Median OS was 30.7 months in the MMC group vs. 46.6 months in the oxaliplatin group (p=0.181). In multivariable analysis, no influence of intraperitoneal drug on survival was observed (adjusted HR 0.77 [0.53–1.13]). Long-term survival between patients treated with either MMC or oxaliplatin during CRS-HIPEC was not significantly different.
ISSN:	0748-7983 1532-2157