Peritoneal carcinomatosis index predicts survival in colorectal patients undergoing HIPEC using oxaliplatin: a retrospective single-arm cohort study

Abstract

Background Peritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for patients with colorectal peritoneal carcinomatosis. However, standardization of HIPEC protocols, including which chemotherapeutic agent to use, is lacking in the literature. Therefore, we sought to report survival outcomes from colorectal cancer patients undergoing CRS/oxaliplatin-based HIPEC at our institution over the last 10 years. Methods Colorectal PC patients treated with CRS/oxaliplatin-based HIPEC 2004–2015 were included. Demographic, clinical, and oncologic data were abstracted from the medical record. Overall (OS) and disease-free survival (DFS) were calculated using Kaplan–Meier analysis. Univariate/multivariate Cox regression analysis was done. Results Laparotomy was performed in 113 patients for colorectal PC; 91 completed a curative intent CRS/HIPEC. At 3 and 5 years, OS for the CRS/HIPEC cohort was 75% and 55%, and DFS was 50% and 25%, respectively. On multivariate analysis, incremental increases in peritoneal carcinomatosis index (PCI) were associated with worse OS ( p = 0.0001) and DFS ( p = 0.0001). Grade III/IV complications were also associated with worse OS. Conclusions A standardized regimen of CRS and oxaliplatin-based HIPEC for colorectal PC is effective with favorable OS and DFS and acceptable complication rates.

Prognostic Value of KRAS Gene Mutation on Survival of Patients with Peritoneal Metastases of Colorectal Adenocarcinoma

“…There was no statistically significant relationship between KRAS status and the median survival. In contrast, four other more recent multicentre studies have found shorter survival in MT-KRAS tumours in which CRS/HIPEC was performed [ 18 , 23 – 25 ]. Morgan et al [ 23 ] analysed the value of KRAS mutation in 47 patients undergoing CRS/HIPEC.…”

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review

“…A summary of patient characteristics from the studies is shown in Table 1. 9 ,22–46 The median patient age in the studies ( n = 22) ranged from 44 to 62 years. Eight studies reported having patients younger than 20 years of age, and 13 studies reported having patients older than 75.…”

“…HIPEC treatment details are available in Table 2. 9,22–46 Treatment protocols in the studies varied, specifically with regard to the timing of the procedure, administration methodology, as well as the therapeutics agent(s) used. The definition of complete cytoreduction (CC) also varied among studies, including CC0 (generally CC0 indicates that no macroscopic peritoneal tumor remains following cytoreduction) and R0 (R refers to resection status; R0 is complete resection) as well as CC1, R1, and/or R2a (classified as CC1 or R2a when tumor nodules less than 2.5 mm persist following cytoreduction; R1 = no macroscopic residual tumor).…”

Imaging Matrix-Assisted Laser Desorption/Ionization Fourier Transform Ion Cyclotron Resonance Mass Spectrometry of oxaliplatin derivatives in human tissue sections

“…HIPEC is one of the most recent treatments enabling a significantly improved survival of the patients. It consists in a local application of a high concentration of warmed anticancer Pt-metallodrugs, such as oxaliplatin, through the peritoneal cavity [28][29][30][31]. In treated women, the intra peritoneal location of ovaries raises the possibility for their contamination with the Pt-drug [13].…”