Abstract 11P
Background
Almost a quarter of patients with locally advanced colon cancer (pT4) develop locoregional recurrence, including peritoneal metastases, which leads to a poor prognosis. Individual randomized controlled trials have shown conflicting results of prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC). This individual patient data meta-analysis (IPDMA) aimed to identify whether specific subgroups of patients might benefit from prophylactic HIPEC.
Methods
A systematic literature search was conducted to identify randomized controlled trials on prophylactic HIPEC in locally advanced colon carcinoma until August 1st, 2023. An IPDMA was performed with 3-year locoregional recurrence rate as primary endpoint and 3-year disease-free survival (DFS) and overall survival (OS) as secondary endpoints.
Results
The search revealed two randomized controlled trials (COLOPEC and HIPECT4). Individual patient data were pooled for 386 patients, of whom 189 patients received prophylactic HIPEC, and 197 patients constituted the control group. Median follow-up was 36 months (IQR 32 – 60). Modified intention to treat analysis resulted in an overall 3-year locoregional recurrence rate of 18% for HIPEC and 25% for control patients (HR 0.75, 95% CI 0.47 – 1.22). Predefined subgroup analyses revealed a significant reduction in 3-year locoregional recurrence after HIPEC in patients with right-sided tumors (HR 0.47; 95%CI 0.29 – 0.77), patients with pN1 stage (HR 0.92; 95% CI 0.85 – 0.99), and patients with right-sided pT4 tumors (HR of 0.47 95% CI 0.29 – 0.77). No significant differences in DFS and OS between HIPEC and control groups were found for the overall study population.
Conclusions
In patients with locally advanced colon cancer, prophylactic HIPEC in addition to surgical resection and adjuvant systemic chemotherapy seems to significantly improve the locoregional recurrence rate in high-risk subgroups. This did not translate into an overall survival benefit, but follow-up is still immature.
Clinical trial identification
COLOPEC: NCT02231086; HIPECT4: NCT02614534.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.