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

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 d...

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Published in:Journal of surgical oncology 2023-03, Vol.127 (3), p.442-449
Main Authors: Hanna, David N., Macfie, Rebekah, Ghani, Muhammad O., Hermina, Andrew, Mina, Alexander, Cha, Da Eun, Bailey, Christina E., Cohen, Noah, Labow, Daniel, Golas, Benjamin, Sarpel, Umut, Magge, Deepa, Idrees, Kamran
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Chemotherapy
Chemotherapy, Cancer, Regional Perfusion
Colorectal cancer
Colorectal Neoplasms - pathology
Combined Modality Therapy
CRS‐HIPEC
Cytoreduction Surgical Procedures
Gastric cancer
Humans
Hyperthermia, Induced
Hyperthermic Intraperitoneal Chemotherapy
Metastasis
Neoadjuvant Therapy
outcomes
peritoneal carcinomatosis
Peritoneal Neoplasms - secondary
Retrospective Studies
Survival Rate
systemic chemotherapy
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Summary: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.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.27136