Daphne Hompes1, Henk Boot, Harm van Tinteren, Victor Verwaal. 1. Department of Gastro-intestinal Surgery, Antoni van Leeuwenhoek Hospital, The Netherlands Cancer Institute, Amsterdam, The Netherlands. d.hompes@nki.nl
Abstract
BACKGROUND AND OBJECTIVES: For unresectable peritoneal carcinomatosis (PC) median overall survival (OS) is 5-6 months. This article analyzes patients with PC from colorectal cancer (CRC) uneligible for debulking and hyperthermic intra-peritoneal chemotherapy, describing patient- and tumor-related factors possibly affecting survival. PATIENTS AND METHODS: From 2005 to 2009, 43 patients presented with unresectable PC from CRC: male/female ratio was 29/14, median age was 57.1 years (range 34.8-76.8). "Unresectability" was defined as: six to seven abdominal regions affected by PC, involvement of mesentery or small bowel in the PC, presence of liver metastases, retroperitoneal lymph nodes, vascular invasion, and/or neural invasion. RESULTS: Median time interval between diagnosis of the primary tumor and diagnosis of PC was 7.2 months (range 0.0-102.3). Primary tumors were right-sided in >50% and had been previously resected in >58%, 74.4% of PC occurred synchronously. Ascites was present at primary diagnosis in 37.2%. In 70% of cases, six to seven abdominal regions were affected and in 58.1% PC involved small bowel/mesentery. Systemic disease was present in 16.3%. In 18.6% of patients, a palliative diversion or ostomy was constructed. Median OS was 6.3 months (range 0.4-33.1). Thirty-one patients (72.1%) received palliative chemotherapy. Median OS was 9.3 months (range 0.9-33.1) with versus 3.1 months (range 0.4-6.5) without chemotherapy (P = 0.000), with less favorable patient and tumor characteristics in the latter group. No other factors clearly influenced OS. CONCLUSION: Palliative chemotherapy results in better OS, but this is probably attributable to factors influencing the patient's general condition.
BACKGROUND AND OBJECTIVES: For unresectable peritoneal carcinomatosis (PC) median overall survival (OS) is 5-6 months. This article analyzes patients with PC from colorectal cancer (CRC) uneligible for debulking and hyperthermic intra-peritoneal chemotherapy, describing patient- and tumor-related factors possibly affecting survival. PATIENTS AND METHODS: From 2005 to 2009, 43 patients presented with unresectable PC from CRC: male/female ratio was 29/14, median age was 57.1 years (range 34.8-76.8). "Unresectability" was defined as: six to seven abdominal regions affected by PC, involvement of mesentery or small bowel in the PC, presence of liver metastases, retroperitoneal lymph nodes, vascular invasion, and/or neural invasion. RESULTS: Median time interval between diagnosis of the primary tumor and diagnosis of PC was 7.2 months (range 0.0-102.3). Primary tumors were right-sided in >50% and had been previously resected in >58%, 74.4% of PC occurred synchronously. Ascites was present at primary diagnosis in 37.2%. In 70% of cases, six to seven abdominal regions were affected and in 58.1% PC involved small bowel/mesentery. Systemic disease was present in 16.3%. In 18.6% of patients, a palliative diversion or ostomy was constructed. Median OS was 6.3 months (range 0.4-33.1). Thirty-one patients (72.1%) received palliative chemotherapy. Median OS was 9.3 months (range 0.9-33.1) with versus 3.1 months (range 0.4-6.5) without chemotherapy (P = 0.000), with less favorable patient and tumor characteristics in the latter group. No other factors clearly influenced OS. CONCLUSION: Palliative chemotherapy results in better OS, but this is probably attributable to factors influencing the patient's general condition.
Authors: Nadine Leonie de Boer; Alexandra R M Brandt-Kerkhof; Eva V E Madsen; Marjolein Diepeveen; Esther van Meerten; Ruben A G van Eerden; Femke M de Man; Rachida Bouamar; Stijn L W Koolen; Ignace H J T de Hingh; Checca Bakkers; Koen P Rovers; Geert-Jan M Creemers; Maarten J Deenen; Onno W Kranenburg; Alexander Constantinides; Ron H J Mathijssen; Cornelis Verhoef; Jacobus W A Burger Journal: BMJ Open Date: 2019-12-08 Impact factor: 2.692