Influence of Modern Systemic Therapies as Adjunct to Cytoreduction and Perioperative Intraperitoneal Chemotherapy for Patients With Colorectal Peritoneal Carcinomatosis: A Multicenter Study (original) (raw)

Abstract

Background

To evaluate the role of modern systemic therapies and its role as palliative or curative therapy for patients with colorectal peritoneal carcinomatosis with an emphasis on patient selection with the colorectal Peritoneal Surface Disease Severity Score (PSDSS).

Methods

From three specialized treatment centers, patients with colorectal peritoneal carcinomatosis were identified between December 1988 to December 2009 to receive best supportive care, standard, or modern systemic therapies. Intent was classified as palliative or curative (if treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy). Patients were stratified according to the PSDSS. Survival was estimated by the Kaplan–Meier method.

Results

Palliative and curative treatment achieved a median survival of 9 (95% confidence interval [95% CI] 5.9–12.8) and 38 (95% CI 30.2–45.2) months, respectively (P < 0.001). The type of chemotherapy in the palliative and curative group influenced outcome (P < 0.001, P = 0.011, respectively). In the palliative group, PSDSS I/II had a median survival of 24 (95% CI 15.6–32.6) and PSDSS III/IV had a median survival of 6 (95% CI 4.9–8.0) months (P < 0.001). In the curative group, PSDSS I/II had a median survival of 49 (95% CI 40.0–58.3) and PSDSS III/IV had a median survival of 31 (95% CI 20.4–40.9) months (P = 0.002).

Conclusions

Modern systemic therapies were associated with improved outcome in patients with colorectal peritoneal carcinomatosis treated systemically alone or with cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Preoperative evaluation with the PSDSS may improve patient selection and optimize outcomes.

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References

  1. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25:4575–80.
    Article PubMed Google Scholar
  2. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247:125–35.
    Article PubMed Google Scholar
  3. Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg. 2007;84:324–38.
    Article PubMed Google Scholar
  4. Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28:63–8.
    Article PubMed Google Scholar
  5. Glehen O, Kwiatkowski F, Sugarbaker PH, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22:3284–92.
    Article PubMed CAS Google Scholar
  6. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.
    Article PubMed Google Scholar
  7. Chua TC, Saxena A, Schelleken JF, et al. Mortality and morbidity outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single tertiary institution: towards a new perspective of this treatment. Ann Surg. 2010;251:101–6.
    Article PubMed Google Scholar
  8. Joerg OWP, Alexander S, Aviram N, Werner H, Jesus E. Evaluation of a Peritoneal Surface Disease Severity Score in patients with colon cancer with peritoneal carcinomatosis. J Surg Oncol. 2009;99:9–15.
    Article Google Scholar
  9. Chua TC, Morris DL, Esquivel J. Impact of the Peritoneal Surface Disease Severity Score on survival in patients with colorectal cancer peritoneal carcinomatosis undergoing a complete cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2010;17:1330–6.
    Article PubMed Google Scholar
  10. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009;27:681–5.
    Article PubMed Google Scholar
  11. Khatri VP. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a panacea or just an obstacle course for the patient? J Clin Oncol. 2010;28:5–7.
    Article PubMed Google Scholar
  12. Franko J, Ibrahim Z, Gusani NJ, Holtzman MP, Bartlett DL, Zeh HJ 3rd. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus sytemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756–62.
    Article PubMed Google Scholar
  13. Choi YI, Lee SH, Ahn BK, et al. Intestinal perforation in colorectal cancers treated with bevacizumab (Avastin). Cancer Res Treat. 2008;40:33–5.
    Article PubMed Google Scholar
  14. Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure?: a systematic review of morbidity and mortality. Ann Surg. 2009;249:900–7.
    Article PubMed Google Scholar
  15. Yan TD, Links M, Fransi S, et al. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy—a journey to becoming a nationally funded peritonectomy center. Ann Surg Oncol. 2007;14:2270–80.
    Article PubMed Google Scholar

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Authors and Affiliations

  1. Hepatobiliary and Surgical Oncology Unit, Department of Surgery, University of New South Wales, St. George Hospital, Sydney, NSW, Australia
    Terence C. Chua MBBS, David L. Morris MD & Akshat Saxena BSc
  2. Department of Medical Oncology, St. George Hospital, Sydney, NSW, Australia
    Winston Liauw MBBS
  3. Department of Surgical Oncology, St. Agnes Hospital, Baltimore, MD, USA
    Jesus Esquivel MD
  4. Department of General, Visceral, and Paediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
    Joerg Doerfer MD, Christoph-Thomas Germer MD, Alexander G. Kerscher MD & Joerg O. W. Pelz MD

Authors

  1. Terence C. Chua MBBS
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  2. David L. Morris MD
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  3. Akshat Saxena BSc
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  4. Jesus Esquivel MD
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  5. Winston Liauw MBBS
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  6. Joerg Doerfer MD
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  7. Christoph-Thomas Germer MD
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  8. Alexander G. Kerscher MD
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  9. Joerg O. W. Pelz MD
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Correspondence toTerence C. Chua MBBS.

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Chua, T.C., Morris, D.L., Saxena, A. et al. Influence of Modern Systemic Therapies as Adjunct to Cytoreduction and Perioperative Intraperitoneal Chemotherapy for Patients With Colorectal Peritoneal Carcinomatosis: A Multicenter Study.Ann Surg Oncol 18, 1560–1567 (2011). https://doi.org/10.1245/s10434-010-1522-1

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