Postoperative oxaliplatin-based hyperthermic intraperitoneal chemotherapy: an effective and safe palliative treatment option for colorectal cancer with peritoneal metastasis

Abstract

Background The prognosis of patients with colorectal cancer and peritoneal metastasis (CRC-PM) after incomplete cytoreductive surgery (CRS) or palliative surgery is poor. Novel and effective therapies are urgently needed. This study aimed to assess the effects of palliative postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with CRC-PM. Methods This retrospective study included patients with CRC-PM at the First Affiliated Hospital of Xi’an Jiaotong University in 05/2014–05/2019. Observation indicators included overall survival (OS), ascites-free survival, peritoneal cancer index (PCI), and completeness of cytoreduction (CC). Kaplan-Meier survival curves and multivariable Cox regression models were used to determine the factors associated with OS and ascites-free survival. The ascites-specific quality of life (QoL) was measured using the Functional Assessment of Chronic Illness Therapy-Ascites Index (FACIT-AI). Results Eighty-two patients were included, including 37 and 45 in the HIPEC and non-HIPEC groups, respectively. Mean OS was 10.3±3.7 (95% CI 9.5–11.2) months. Multivariable Cox proportional hazard regression suggested that PCI (HR=6.086, 95% CI 3.187–11.620, P < 0.0001) was independently associated with OS. The degree of ascites (HR=2.059, 95% CI 1.412–3.005, P < 0.0001), PCI (HR=6.504, 95% CI 2.844–14.875, P < 0.0001), and HIPEC (HR=0.328, 95% CI 0.191–0.562, P < 0.0001) were independently associated with ascites-free survival. In patients with survival >6 months, postoperative ascites-specific QoL was significantly improved after HIPEC compared with the non-HIPEC group (P < 0.001). Oxaliplatin-based HIPEC significantly increased the rates of neutropenia and peripheral neurotoxicity (both P < 0.05). Conclusion These data indicate that postoperative oxaliplatin-based HIPEC might help increase ascites-free survival in CRC-PM patients after incomplete CRS or palliative surgery, with improved QoL after 6 months of follow-up.

Oxaliplatin-induced peripheral neurotoxicity in colorectal cancer patients: mechanisms, pharmacokinetics and strategies

“…However, the most common grade 3–4 side effects with HIPEC were haemorrhage, digestive leakage, and haematological adverse events, and no neurotoxicity appeared to be observed ( Goéré et al, 2020 ; Quénet et al, 2021 ). However, a retrospective study suggested that postoperative oxaliplatin-based HIPEC might contribute to improve ascites-free survival, but is accompanied by high neurotoxicity ( Sun et al, 2021 ). Therefore, it requires further studies with large samples to observe the antitumor activity and OIPN of HIPEC oxaliplatin.…”

The role of chemotherapy in the treatment of advanced appendiceal cancers: summary of the literature and future directions

“…This has not been clearly evaluated in the literature, and current clinical practice at most institutions favour initial MMC-HIPEC to facilitate initial oxaliplatin-based systemic chemotherapy to reduce the dose-limiting risk of neurotoxicity. 115,117 Oxaliplatin HIPEC. The use of oxaliplatin-HIPEC has been controversial in the CRC setting.…”

Intraperitoneal administration of thermosensitive hydrogel Co-loaded with norcantharidin nanoparticles and oxaliplatin inhibits malignant ascites of hepatocellular carcinoma

“…The combination of two or more anti-tumor drugs can synergistically inhibit the growth of peritoneal masses (Yang et al, 2018 ). Oxaliplatin has proved to be highly effective for the palliative in-situ treatment of metastatic peritoneal cancer (Sun et al, 2021 ). Norcantharidin (NCTD), a demethylated derivative of zebularine, is a natural product with potent anti-tumor effects against multiple cancers, including liver cancer (Liu et al, 1995 ; 2020 ).…”