Marianne Maillet1, Olivier Glehen2, Jerome Lambert3, Diane Goere4, Marc Pocard5, Simon Msika6, Guillaume Passot2, Dominique Elias4, Clarisse Eveno5, Jean-Marc Sabaté7, Nelson Lourenco1, Thierry André8, Jean-Marc Gornet9. 1. Department of Gastroenterology, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France. 2. Department of Digestive Surgery CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France. 3. Department of Biostatistics, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France. 4. Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France. 5. Surgical Oncologic & Digestive Unit, AP-HP, Hôpital Lariboisière, Université Paris-Diderot (USPC), Paris, France. 6. Department of Digestive Surgery, AP-HP, Hôpital Louis Mourier, Université Paris-Diderot (USPC), Colombes, France. 7. Department of Hepato-Gastroenterology, AP-HP, Hôpital Louis Mourier, Université Paris-Diderot (USPC), Colombes, France. 8. Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, Université Pierre et Marie Curie (UMPC), Paris, France. 9. Department of Gastroenterology, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France. jean-marc.gornet@aphp.fr.
Abstract
PURPOSE: The prognosis of peritoneal carcinomatosis (PC) from colorectal cancer has been improved with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, benefits of postoperative chemotherapy (CT) are unclear. METHODS: This retrospective, multicenter study included 231 patients treated by CRS and HIPEC for isolated PC of colon cancer in four expert's centers. Overall survival (OS), progression-free survival (PFS), and peritoneal recurrence-free survival (PRFS) were compared between patients with adjuvant CT (started within 3 months after surgery) and patients with surveillance only. RESULTS: After exclusion of 10 patients for early postoperative death (4%), 221 patients were included (CT group: n = 151; surveillance group: n = 70). Main postoperative CT regimens (median of 6 cycles) were Folfox (28%), Folfiri bevacizumab (24.5%), Folfiri (16%), and Folfiri cetuximab (12.5%). The median OS after surgery was 43.3 months with no difference between CT and surveillance groups. In multivariate analysis, a low peritoneal cancer index (p < 0.0001) and a long delay between diagnosis of CP and HIPEC (p = 0.001) were associated with increased OS. The median PFS and PRFS were 12.4 and 17 months, respectively. At 1 year, more patients were without progression (p = 0.001) or PC recurrence (0.0004) in the CT group, but with prolonged follow-up this difference was no longer significant. CONCLUSIONS: Early postoperative CT does not improve OS after CRS and HIPEC for colon carcinomatosis. However, a transient effect on PFS and PRFS was observed. A subgroup of patients who may benefit more from CT remain to be defined.
PURPOSE: The prognosis of peritoneal carcinomatosis (PC) from colorectal cancer has been improved with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, benefits of postoperative chemotherapy (CT) are unclear. METHODS: This retrospective, multicenter study included 231 patients treated by CRS and HIPEC for isolated PC of colon cancer in four expert's centers. Overall survival (OS), progression-free survival (PFS), and peritoneal recurrence-free survival (PRFS) were compared between patients with adjuvant CT (started within 3 months after surgery) and patients with surveillance only. RESULTS: After exclusion of 10 patients for early postoperative death (4%), 221 patients were included (CT group: n = 151; surveillance group: n = 70). Main postoperative CT regimens (median of 6 cycles) were Folfox (28%), Folfiribevacizumab (24.5%), Folfiri (16%), and Folfiricetuximab (12.5%). The median OS after surgery was 43.3 months with no difference between CT and surveillance groups. In multivariate analysis, a low peritoneal cancer index (p < 0.0001) and a long delay between diagnosis of CP and HIPEC (p = 0.001) were associated with increased OS. The median PFS and PRFS were 12.4 and 17 months, respectively. At 1 year, more patients were without progression (p = 0.001) or PC recurrence (0.0004) in the CT group, but with prolonged follow-up this difference was no longer significant. CONCLUSIONS: Early postoperative CT does not improve OS after CRS and HIPEC for colon carcinomatosis. However, a transient effect on PFS and PRFS was observed. A subgroup of patients who may benefit more from CT remain to be defined.
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Authors: Charlotte E L Klaver; Roos Stam; Didi A M Sloothaak; Johannes Crezee; Willem A Bemelman; Cornelis J A Punt; Pieter J Tanis Journal: Oncotarget Date: 2017-04-17
Authors: Vignesh Narasimhan; Satish Warrier; Michael Michael; Jacob McCormick; Robert Ramsay; Craig Lynch; Alexander Heriot Journal: Pleura Peritoneum Date: 2019-10-30