Two bi-institutional prospective studies using intraperitoneal oxaliplatin with or without irinotecan during HIPEC following complete cytoreductive surgery for colorectal carcinomatosis.

Abstract

486 Background: In treatment of peritoneal carcinomatosis (PC) of colorectal origin, studies combining cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) have shown encouraging survival results. Intraperitoneal drugs usually used are mitomycin C or oxaliplatin in monotherapy. The aim of this study was to assess long-term survival in patients treated with a new combination of oxaliplatin and irinotecan (ox-irino) and to compare it with that obtained with oxaliplatin alone (ox-alone). Methods: Two bi-institutional prospective studies were carried out. All patients with PC who had undergone CRS with HIPEC using either ox-alone 460 mg/m2 or ox-irino (ox: 300 mg/m2 and irino: 200 mg/m2) from January 1998 to December 2007 were included. Results: 146 patient underwent CRS + HIPEC for PC from colorectal carcinoma. 103 patients received ox-irino and 43 patients received ox-alone HIPEC. The overall mortality rate was 4.1%. The overall morbidity rate was 47.2%. It was significantly lower in the ox-alone group compared to the ox-irino group (34.9% vs. 52.4%, p =0.05). After a median follow-up of 48.5 months, (95%CI 41.0-56.3), the median OS was 41 months (95%CI 32-60) and the median RFS was 15.7 months (95%CI 12-18). The median RFS of the ox-alone group was 16.8 months (95%CI 11-25) and was not significantly different from that of ox-irino group (15.7 months, 95%CI 11-18, p = 0.93). There was no significant difference between the median OS of the ox-alone group (40.83 months, 95%CI 29–61) and the ox-irino group (47 months, 95%CI 32-61, p = 0.94). At 5 years, the OS and the RFS rates were respectively 41.8% (95% CI 25.20-57.58) and 13.8% (95% CI 4.66-27.84) in the ox-alone group and 42.4% (95% CI 28.52-56.09) and 14.2% (95% CI 6.27-25.20) in the ox-irino group. Conclusions: This study confirms the interesting survival results of CRS + HIPEC to treat colorectal PC. 460 mg/m2 of oxaliplatin alone HIPEC is as efficient as 300 mg/m2 of oxaliplatin associated with 200 mg/m2 of irinotecan, but with lower morbidity. Ox-alone HIPEC, should remain the current gold standard. No significant financial relationships to disclose.

Linear Relationship of Peritoneal Cancer Index and Survival in Patients with Peritoneal Metastases from Colorectal Cancer

“…As demonstrated in large multicenter studies, the first selection criterion is obviously the possibility to achieve complete resection of PM. 1,3,6,21 This condition could not be investigated in our center because we have never performed HIPEC after incomplete cytoreductive surgery. The second selection criteria is the PCI, which strongly outdistances all the other prognostic factors in large published series.…”

“…The second selection criteria is the PCI, which strongly outdistances all the other prognostic factors in large published series. 1,3,[5][6][7][8] A PCI cutoff that could be associated with a favorable survival rate has been proposed in several series. With time and experience, this cutoff has progressively decreased, but it remains unset.…”

“…However, some patients still benefit from potentially curative treatment that includes optimal resection of PM followed by hyperthermic intraperitoneal chemotherapy (HIPEC). [1][2][3][4][5][6][7][8] It has been shown that the extent of PM, which is scored by the peritoneal cancer index (PCI), is by far the most important prognostic factor. [5][6][7][8][9] This PCI, ranging from 1 to 39, was first designed and published in 1998 by Sugarbaker.…”

Is Intraperitoneal Chemotherapy After Cytoreductive Surgery Efficient? Knowing Whether It Is or Not Appears Secondary!

“…6 Similarly, no difference was found between the patients treated with oxaliplatin alone and those treated with oxaliplatin ? irinotecan in the study by Quenet et al 10 Also, when the different temperatures and the different durations used during HIPEC were compared, even if the teams used other uncomparable parameters, there was no obvious superiority of high temperatures (42-44°C) over low temperatures (40-41°C), nor was there superiority of a long duration (C60 min) over a short duration (\60 min).…”

Ninety percent of the adverse outcomes occur in 10% of patients: can we identify the populations at high risk of developing peritoneal metastases after curative surgery for colorectal cancer?

“…Peritoneal metastases (PM) occur in 3.4-6.3% of patients after curative surgery for non-metastatic colorectal cancer [1][2][3][4][5][6][7]. Patients with PM have a spontaneous poor prognosis and median survival is 22 months at best with the latest drug regimens [7][8][9]. In comparison, a more aggressive approach combining complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) enables a 5year overall survival rate of 42% and a median survival of 41 months [10].…”