Hyperthermic intraperitoneal chemotherapy + early postoperative intraperitoneal chemotherapy versus hyperthermic intraperitoneal chemotherapy alone: assessment of survival outcomes for colorectal and high-grade appendiceal peritoneal carcinomatosis

Am J Surg. 2015 Sep;210(3):424-30. doi: 10.1016/j.amjsurg.2015.03.008. Epub 2015 May 12.

Abstract

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have improved survival for colorectal and high-grade appendiceal carcinomatosis. We compared the overall and recurrence-free survival (OS and RFS) of patients treated with HIPEC with mitomycin c and early postoperative intraperitoneal chemotherapy (EPIC) with fluorouracil versus HIPEC alone using oxaliplatin and simultaneous IV infusion of fluorouracil.

Methods: Ninety-three patients with colorectal or high-grade appendiceal carcinomatosis were treated with CRS and HIPEC + EPIC or HIPEC alone. OS and RFS were analyzed using Kaplan-Meier curves and log-rank testing.

Results: Survival did not differ between HIPEC regimens. The 3-year OS and RFS rates were 50% and 21% for HIPEC + EPIC and 46% and 6% for HIPEC alone (P = .72 and P = .89, respectively). HIPEC + EPIC patients experienced more grade III/IV complications (43.2% vs 19.6%, P = .01).

Conclusions: There was no difference in OS and RFS between colorectal and high-grade appendiceal adenocarcinoma patients treated with CRS and HIPEC + EPIC versus HIPEC alone. However, HIPEC + EPIC patients suffered greater morbidity, making HIPEC alone the preferable regimen.

Keywords: Colorectal cancer; Cytoreduction; HIPEC; Peritoneal carcinomatosis; Survival.

Publication types

  • Comparative Study

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / therapy
  • Adenocarcinoma, Mucinous / mortality
  • Adenocarcinoma, Mucinous / therapy
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Appendiceal Neoplasms / mortality
  • Appendiceal Neoplasms / therapy
  • Chemotherapy, Adjuvant
  • Chemotherapy, Cancer, Regional Perfusion*
  • Colorectal Neoplasms / mortality*
  • Colorectal Neoplasms / therapy*
  • Cytoreduction Surgical Procedures*
  • Female
  • Fluorouracil / administration & dosage
  • Humans
  • Hyperthermia, Induced*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Organoplatinum Compounds / administration & dosage
  • Oxaliplatin
  • Peritoneal Neoplasms / mortality*
  • Peritoneal Neoplasms / therapy*

Substances

  • Organoplatinum Compounds
  • Oxaliplatin
  • Fluorouracil