The American Society of Peritoneal Surface Malignancies evaluation of HIPEC with Mitomycin C versus Oxaliplatin in 539 patients with colon cancer undergoing a complete cytoreductive surgery

J Surg Oncol. 2014 Dec;110(7):779-85. doi: 10.1002/jso.23728. Epub 2014 Aug 2.


Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are gaining acceptance as treatment for selected patients with colorectal cancer with peritoneal carcinomatosis (CRCPC). Tremendous variations exist in the HIPEC delivery.

Methods: The American Society of Peritoneal Surface Malignancies (ASPSM) examined the overall survival in patients with CRCPC who underwent a complete cytoreduction and HIPEC with Oxaliplatin vs. Mitomycin C (MMC), stratifying them by the Peritoneal Surface Disease Severity Score (PSDSS).

Results: Median overall survival (OS) of 539 patients with complete cytoreduction was 32.6 months, 32.7 months for the MMC group and 31.4 months for the Oxaliplatin group (P = 0.925). However, when stratified by PSDSS, median OS rates in PSDSS I/II patients were 54.3 months in those receiving MMC vs. 28.2 months in those receiving oxaliplatin (P = 0.012), whereas in PSDSS III/IV patients, median OS rates were 19.4 months in those receiving MMC vs. 30.4 months in those receiving Oxaliplatin (P = 0.427).

Conclusion: These data suggest that MMC might be a better agent for HIPEC delivery than Oxaliplatin in patients with CRCPC, favorable histologies and low burden of disease (PSDSS I/II) undergoing complete cytoreduction. Prospective studies are warranted, which stratify patients by their PSDSS and randomize them to HIPEC with MMC vs. Oxaliplatin.

Keywords: colorectal cancer with peritoneal carcinomatosis; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy (HIPEC).

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Antibiotics, Antineoplastic / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Chemotherapy, Cancer, Regional Perfusion*
  • Colorectal Neoplasms / mortality
  • Colorectal Neoplasms / pathology
  • Colorectal Neoplasms / therapy*
  • Combined Modality Therapy
  • Digestive System Surgical Procedures*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermia, Induced*
  • Injections, Intraperitoneal
  • Male
  • Middle Aged
  • Mitomycin / therapeutic use*
  • Neoplasm Staging
  • Organoplatinum Compounds / therapeutic use*
  • Oxaliplatin
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / therapy*
  • Prognosis
  • Retrospective Studies
  • Survival Rate


  • Antibiotics, Antineoplastic
  • Antineoplastic Agents
  • Organoplatinum Compounds
  • Oxaliplatin
  • Mitomycin