Top

Published in:

Open Access 01-08-2018 | Colorectal Cancer

Metachronous Peritoneal Metastases After Adjuvant Chemotherapy are Associated with Poor Outcome After Cytoreduction and HIPEC

Authors: Nina R. Sluiter, MD, Koen P. Rovers, MD, Youssra Salhi, BSc, Stijn L. Vlek, MD, Veerle M. H. Coupé, MD, PhD, Henk M. W. Verheul, MD, PhD, Geert Kazemier, MD, PhD, Ignace H. J. T. de Hingh, MD, PhD, Jurriaan B. Tuynman, MD, PhD

Published in: Annals of Surgical Oncology | Issue 8/2018

Abstract

Introduction

Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of colorectal cancer (CRC) patients with peritoneal metastases. Patient selection is key since this treatment is associated with high morbidity. Patients with peritoneal recurrence within 1 year after previous adjuvant chemotherapy are thought to benefit less from HIPEC treatment; however, no published data are available to assist in clinical decision making. This study assessed whether peritoneal recurrence within 1 year after adjuvant chemotherapy was associated with survival after HIPEC treatment.

Methods

Peritoneal recurrence within 1 year after adjuvant chemotherapy, as well as other potentially prognostic clinical and pathological variables, were tested in univariate and multivariate analysis for correlation with primary outcomes, i.e. overall survival (OS) and disease-free survival (DFS). Two prospectively collected databases from the VU University Medical Center Amsterdam and Catherina Hospital Eindhoven containing 345 CRC patients treated with the intent of HIPEC were utilized.

Results

High Peritoneal Cancer Index (PCI) scores were associated with worse DFS [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.00–1.08, p = 0.040] and OS (HR 1.11, 95% CI 1.07–1.15, p < 0.001) in multivariate analysis. Furthermore, patients with peritoneal recurrence within 1 year following adjuvant chemotherapy had worse DFS (HR 2.13, 95% CI 1.26–3.61, p = 0.005) and OS (HR 2.76, 95% CI 1.45–5.27, p = 0.002) than patients who did not receive adjuvant chemotherapy or patients with peritoneal recurrence after 1 year.

Conclusion

Peritoneal recurrence within 1 year after previous adjuvant chemotherapy, as well as high PCI scores, are associated with poor survival after cytoreduction and HIPEC. These factors should be considered in order to avoid high-morbidity treatment in patients who might not benefit from such treatment.

Available only for authorised users

Mirnezami R, Mehta AM, Chandrakumaran K, et al. Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy alone. Br J Cancer. 2014;111(8):1500–1508.CrossRefPubMedPubMedCentral

Verwaal VJ, Zoetmulder FA. Follow-up of patients treated by cytoreduction and chemotherapy for peritoneal carcinomatosis of colorectal origin. Eur J Surg Oncol. 2004;30(3):280–285.CrossRefPubMed

Franko J, Ibrahim Z, Gusani NJ, Holtzman MP, Bartlett DL, Zeh HJ 3rd. Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis. Cancer. 2010;116(16):3756–3762.CrossRefPubMed

Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21(20):3737–3743.CrossRefPubMed

Bloemendaal AL, Verwaal VJ, van Ruth S, Boot H, Zoetmulder FA. Conventional surgery and systemic chemotherapy for peritoneal carcinomatosis of colorectal origin: a prospective study. Eur J Surg Oncol. 2005;31(10):1145–1151.CrossRefPubMed

Elias D, Gilly F, Boutitie F, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63–68.CrossRefPubMed

Kuijpers AM, Mirck B, Aalbers AG, et al. Cytoreduction and HIPEC in the Netherlands: nationwide long-term outcome following the Dutch protocol. Ann Surg Oncol. 2013;20(13):4224–4230.CrossRefPubMedPubMedCentral

Randle RW, Doud AN, Levine EA, et al. Peritoneal surface disease with synchronous hepatic involvement treated with Cytoreductive Surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol. 2015;22(5):1634–1638.CrossRefPubMed

Saxena A, Yan TD, Morris DL. A critical evaluation of risk factors for complications after cytoreductive surgery and perioperative intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. World J Surg. 2010;34(1):70–78.CrossRefPubMed

10.

Ihemelandu CU, McQuellon R, Shen P, Stewart JH, Votanopoulos K, Levine EA. Predicting postoperative morbidity following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CS + HIPEC) with preoperative FACT-C (Functional Assessment of Cancer Therapy) and patient-rated performance status. Ann Surg Oncol. 2013;20(11):3519–3526.CrossRefPubMed

11.

Kwakman R, Schrama AM, van Olmen JP, et al. Clinicopathological parameters in patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer metastases: a meta-analysis. Ann Surg. 2016;263(6):1102–1111.CrossRefPubMed

12.

Sluiter NR, de Cuba EM, Kwakman R, et al. Versican and vascular endothelial growth factor expression levels in peritoneal metastases from colorectal cancer are associated with survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Clin Exp Metastasis. 2016;33(4):297–307.CrossRefPubMedPubMedCentral

13.

de Cuba EM, de Hingh IH, Sluiter NR, et al. Angiogenesis-related markers and prognosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for metastatic colorectal cancer. Ann Surg Oncol. 2016;23(5):1601–1608.CrossRefPubMedPubMedCentral

14.

Simkens GA, van Oudheusden TR, Nieboer D, et al. Development of a prognostic nomogram for patients with peritoneally metastasized colorectal cancer treated with cytoreductive surgery and HIPEC. Ann Surg Oncol. 2016;23(13):4214–4221.CrossRefPubMed

15.

Demey K, Wolthuis A, de Buck van Overstraeten A, et al. External validation of the prognostic nomogram (COMPASS) for patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol. 2017;24(12):3604–3608.CrossRefPubMed

16.

Elias D, Delperro JR, Sideris L, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004;11(5):518–521.CrossRefPubMed

17.

Quenet F, Goere D, Mehta SS, et al. Results of two bi-institutional prospective studies using intraperitoneal oxaliplatin with or without irinotecan during HIPEC after cytoreductive surgery for colorectal carcinomatosis. Ann Surg. 2011;254(2):294–301.CrossRefPubMed

18.

Esquivel J. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: survival outcomes and patient selection. J Gastrointest Oncol. 2016;7(1):72–78.PubMedPubMedCentral

19.

Dube P, Sideris L, Law C, et al. Guidelines on the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy arising from colorectal or appendiceal neoplasms. Curr Oncol. 2015;22(2):e100–112.CrossRefPubMedPubMedCentral

20.

Sugarbaker PH. Patient selection and treatment of peritoneal carcinomatosis from colorectal and appendiceal cancer. World J Surg. 1995;19(2):235–240.CrossRefPubMed

21.

Elias D, Blot F, El Otmany A, et al. Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer. 2001;92(1):71–76.CrossRefPubMed

22.

Sugarbaker PH. Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol. 1998;14(3):254–261.CrossRefPubMed

23.

Verwaal VJ, van Ruth S, Witkamp A, Boot H, van Slooten G, Zoetmulder FA. Long-term survival of peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2005;12(1):65–71.CrossRefPubMed

24.

Trotti A, Colevas AD, Setser A, et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;13(3):176–181.CrossRefPubMed

25.

Werkgroep Colorectaal Carcinoom. Richtlijn Colorectaal Carcinoom. 2014. http://www.oncoline.nl/colorectaalcarcinoom. Accessed 1 Feb 2018.

26.

Klaver YL, de Hingh IH, Boot H, Verwaal VJ. Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy after early failure of adjuvant systemic chemotherapy. J Surg Oncol. 2011;103(5):431–434.CrossRefPubMed

27.

Passot G, Vaudoyer D, Cotte E, et al. Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis. Ann Surg. 2012;256(1):125–129.CrossRefPubMed

28.

Koh JL, Yan TD, Glenn D, Morris DL. Evaluation of preoperative computed tomography in estimating peritoneal cancer index in colorectal peritoneal carcinomatosis. Ann Surg Oncol. 2009;16(2):327–333.CrossRefPubMed

29.

Chang MC, Chen JH, Liang JA, Huang WS, Cheng KY, Kao CH. PET or PET/CT for detection of peritoneal carcinomatosis: a meta-analysis. Clin Nucl Med. 2013;38(8):623–629.CrossRefPubMed

30.

Grass F, Vuagniaux A, Teixeira-Farinha H, Lehmann K, Demartines N, Hubner M. Systematic review of pressurized intraperitoneal aerosol chemotherapy for the treatment of advanced peritoneal carcinomatosis. Br J Surg. 2017;104(6):669–678.CrossRefPubMed

31.

Demtroder C, Solass W, Zieren J, Strumberg D, Giger-Pabst U, Reymond MA. Pressurized intraperitoneal aerosol chemotherapy with oxaliplatin in colorectal peritoneal metastasis. Colorectal Dis. 2016;18(4):364–371.CrossRefPubMed

32.

Kwakman R, de Cuba EM, de Winter JP, et al. Tailoring heated intraperitoneal mitomycin C for peritoneal metastases originating from colorectal carcinoma: a translational approach to improve survival. Br J Cancer. 2015;112(5):851–856.CrossRefPubMedPubMedCentral

Title: Metachronous Peritoneal Metastases After Adjuvant Chemotherapy are Associated with Poor Outcome After Cytoreduction and HIPEC
Authors: Nina R. Sluiter, MD
Koen P. Rovers, MD
Youssra Salhi, BSc
Stijn L. Vlek, MD
Veerle M. H. Coupé, MD, PhD
Henk M. W. Verheul, MD, PhD
Geert Kazemier, MD, PhD
Ignace H. J. T. de Hingh, MD, PhD
Jurriaan B. Tuynman, MD, PhD
Publication date: 01-08-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6539-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Metachronous Peritoneal Metastases After Adjuvant Chemotherapy are Associated with Poor Outcome After Cytoreduction and HIPEC

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2018

Neoadjuvant Therapy Improves Outcomes in Locally Advanced Signet-Ring-Cell Containing Esophagogastric Adenocarcinomas

Compliance with an Enhanced Recovery After a Surgery Program for Patients Undergoing Gastrectomy for Gastric Carcinoma: A Phase 2 Study

Cost Effectiveness of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Management of Colorectal Peritoneal Carcinomatosis

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

The Impact of Pathological Tumor Regression and Nodal Status on Survival and Systemic Disease in Patients Undergoing Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

Clinical Role of Programmed Cell Death-1 Expression in Patients with Non-muscle-invasive Bladder Cancer Recurring After Initial Bacillus Calmette–Guérin Therapy