Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have become a standard treatment option for peritoneal carcinomatosis (PC) arising from colorectal carcinoma, despite the complexity and morbidity of this procedure. The timing of CRS+HIPEC in the course of the disease in unclear, and there is no consensus regarding pre-operative treatments. In this study we analyzed the effect of neoadjuvant systemic chemotherapy prior to CRS+HIPEC on patients' outcome.
Data on consecutive colorectal patients with PC, treated in the Sourasky Medical Center from Jan 2007 to Dec 2016 was collected. Demographic, pathologic and clinical data was registered for all patients. For patients treated with neoadjuvant chemotherapy, the regimen, duration and responses were recorded. Outcome measurements were postoperative complications, progression free survival (PFS) and overall survival (OS).
Seventy-two (72) patients were identified, of whom 43 (59.7%) were treated with neoadjuvant chemotherapy and 29 (40.3%) were referred directly to CRS+HIPEC. No significant demographic, pathological or clinical differences between the groups were found. Median PFS was 12 months in the Neo- group and 17 months in the Neo+ group (p = 0.015). On multivariate Cox-PH analysis, the effect of neoadjuvant chemotherapy on PFS was maintained (HR = 0.34, p = 0.002). Median OS was 41 months in the Neo- and 47 months in the Neo+ with no statistical difference. In the Neo+ group, on univariate analysis, there was no significant effect to chemotherapy regimen, duration of treatment, nor best response. There was no difference in postoperative complication rate between the groups.
In patients candidate for CRS+HIPEC for the treatment of PC from colorectal cancer, the administration of systemic neoadjuvant chemotherapy significantly prolongs PFS with no additional postoperative risks. Prospective randomized trials and larger patient cohorts are needed to confirm these findings and assess the effect on OS.
Clinical trial identification
Legal entity responsible for the study
Tel Aviv University
R. Geva: Advisory board member: Bayer, MSD, Novartis. Honoraria: BMS, Lilly, Medison, Roche, Novartis, Janssen: Travel expenses: Roche, BMS All other authors have declared no conflicts of interest.