Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2019

Open Access 01-12-2019 | Surgery | Research

Neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a feasibility and safety study

Authors: M. Leimkühler, P. H. J. Hemmer, A. K. L. Reyners, D. J. A. de Groot, R. J. van Ginkel, L. B. Been, G. H. de Bock, B. L. van Leeuwen

Published in: World Journal of Surgical Oncology | Issue 1/2019

Login to get access

Abstract

Background

Standard treatment for colorectal peritoneal carcinomatosis typically involves cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and if possible, postoperative adjuvant chemotherapy. However, a substantial percentage of patients never receive adjuvant chemotherapy because of postoperative complications. Neoadjuvant chemotherapy could be beneficial in this setting, so we assessed its feasibility and safety when used before cytoreductive surgery and HIPEC.

Methods

In this non-randomized, single-center, observational feasibility study, patients were scheduled to receive six cycles of capecitabine and oxaliplatin before cytoreductive surgery and HIPEC. Computed tomography was performed after the third and sixth chemotherapy cycles to evaluate tumor response, and patients underwent cytoreductive surgery and HIPEC if there were no pulmonary and/or hepatic metastases. Postoperative complications, graded according to the Clavien–Dindo classification, were compared with those of a historic control group that received postoperative adjuvant chemotherapy.

Results

Of the 14 patients included in the study, 4 and 3 had to terminate neoadjuvant chemotherapy early because of toxicity and tumor progression, respectively. Cytoreductive surgery and HIPEC were performed in eight patients, and the timing and severity of complications were comparable to those of patients in the historic control group treated without neoadjuvant chemotherapy.

Conclusion

Patients with peritoneal metastases due to colorectal carcinoma can be treated safely with neoadjuvant chemotherapy before definitive therapy with cytoreductive surgery and HIPEC.

Trial registration number

Literature
1.
Cao C, Yan TD, Black D, Morris DL. A systematic review and meta-analysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2009 Aug;16(8):2152–65.CrossRef
2.
Gomez Portilla A, Barrios P, Rufian S, Camps B, Bretcha P, Gonzalez Bayon L, et al. Management of peritoneal surface malignancy with cytoreductive surgery and perioperative intraperitoneal chemotherapy. Eur J Surg Oncol. 2006 Aug;32(6):628–31.
3.
Jayne DG, Fook S, Loi C, Seow-Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002 Dec;89(12):1545–50.CrossRef
4.
Mahteme H, Hansson J, Berglund A, Pahlman L, Glimelius B, Nygren P, et al. Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer. 2004 Jan 26;90(2):403–7.
5.
de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000 Aug;18(16):2938–47.
6.
Kuramochi H, Ando M, Itabashi M, Nakajima G, Kawakami K, Hamano M, et al. Phase II study of bevacizumab and irinotecan as second-line therapy for patients with metastatic colorectal cancer previously treated with fluoropyrimidines, oxaliplatin, and bevacizumab. Cancer Chemother Pharmacol. 2017 Mar;79(3):579–85.
7.
Glehen O, Kwiatkowski F, Sugarbaker PH, Elias D, Levine EA, De Simone M, et al. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004 Aug 15;22(16):3284–92.CrossRef
8.
Elias D, Delperro JR, Sideris L, Benhamou E, Pocard M, Baton O, et al. Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol. 2004 May;11(5):518–21.CrossRef
9.
Ung L, Chua TC, David LM. Peritoneal metastases of lower gastrointestinal tract origin: a comparative study of patient outcomes following cytoreduction and intraperitoneal chemotherapy. J Cancer Res Clin Oncol. 2013 Nov;139(11):1899–908.CrossRef
10.
Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol. 2009 Feb 10;27(5):681–5.CrossRef
11.
Esquivel J, Lowy AM, Markman M, Chua T, Pelz J, Baratti D, et al. The American Society of Peritoneal Surface Malignancies (ASPSM) multiinstitution evaluation of the peritoneal surface disease severity score (PSDSS) in 1,013 patients with colorectal cancer with peritoneal carcinomatosis. Ann Surg Oncol. 2014 Dec;21(13):4195–201.CrossRef
12.
van Leeuwen BL, Graf W, Pahlman L, Mahteme H. Swedish experience with peritonectomy and HIPEC. HIPEC in peritoneal carcinomatosis. Ann Surg Oncol. 2008 Mar;15(3):745–53.CrossRef
13.
Verwaal VJ, van Ruth S, de Bree E, van Sloothen GW, van Tinteren H, Boot H, 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 Oct 15;21(20):3737–43.CrossRef
14.
Robella M, Vaira M, Cinquegrana A, Borsano A, DE Simone M. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: risk factors for morbidity and postoperative outcome. Minerva Chir. 2018.
15.
van Eden WJ, Kok NFM, Woensdregt K, Huitema ADR, Boot H, Aalbers AGJ. Safety of intraperitoneal Mitomycin C versus intraperitoneal oxaliplatin in patients with peritoneal carcinomatosis of colorectal cancer undergoing cytoreductive surgery and HIPEC. Eur J Surg Oncol. 2018 Feb;44(2):220–7.CrossRef
16.
Shankar A, Leonard P, Renaut AJ, Lederman J, Lees WR, Gillams AR, et al. Neo-adjuvant therapy improves resectability rates for colorectal liver metastases. Ann R Coll Surg Engl. 2001 Mar;83(2):85–8.PubMedPubMedCentral
17.
Karanjia ND, Lordan JT, Fawcett WJ, Quiney N, Worthington TR. Survival and recurrence after neo-adjuvant chemotherapy and liver resection for colorectal metastases: a ten year study. Eur J Surg Oncol. 2009 Aug;35(8):838–43.CrossRef
18.
Passot G, Vaudoyer D, Cotte E, You B, Isaac S, Noel Gilly F, et al. Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis. Ann Surg. 2012 Jul;256(1):125–9.CrossRef
19.
van Dijk TH, Tamas K, Beukema JC, Beets GL, Gelderblom AJ, de Jong KP, et al. Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol. 2013 Jul;24(7):1762–9.CrossRef
20.
Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 Published: May 28, 2009 (v4.03: June 14, 2010) U.S. Department Of Health And Human Services.
21.
Harlaar NJ, Koller M, de Jongh SJ, van Leeuwen BL, Hemmer PH, Kruijff S, et al. Molecular fluorescence-guided surgery of peritoneal carcinomatosis of colorectal origin: a single-centre feasibility study. Lancet Gastroenterol Hepatol. 2016 Dec;1(4):283–90.CrossRef
22.
Klaver CE, Musters GD, Bemelman WA, Punt CJ, Verwaal VJ, Dijkgraaf MG, et al. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial. BMC Cancer. 2015 May 24;15:7.CrossRef
23.
Esquivel J, Elias D, Baratti D, Kusamura S, Deraco M. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol. 2008 Sep 15;98(4):263–7.CrossRef
24.
Seymour L, Bogaerts J, Perrone A, Ford R, Schwartz LH, Mandrekar S, et al. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017 Mar;18(3):e152.CrossRef
25.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187–96.CrossRef
26.
Liu F, Yang L, Wu Y, Li C, Zhao J, Keranmu A, et al. CapOX as neoadjuvant chemotherapy for locally advanced operable colon cancer patients: a prospective single-arm phase II trial. Chin J Cancer Res. 2016 Dec;28(6):589–97.CrossRef
27.
Takahashi T, Shibata Y, Tojima Y, Tsuboi K, Sakamoto E, Kunieda K, et al. Multicenter phase II study of modified FOLFOX6 as neoadjuvant chemotherapy for patients with unresectable liver-only metastases from colorectal cancer in Japan: ROOF study. Int J Clin Oncol. 2013 Apr;18(2):335–42.CrossRef
28.
Takatsuki M, Tokunaga S, Uchida S, Sakoda M, Shirabe K, Beppu T, et al. Evaluation of resectability after neoadjuvant chemotherapy for primary non-resectable colorectal liver metastases: a multicenter study. Eur J Surg Oncol. 2016 Feb;42(2):184–9.CrossRef
29.
Simkens GA, van Oudheusden TR, Luyer MD, Nienhuijs SW, Nieuwenhuijzen GA, Rutten HJ, et al. Serious postoperative complications affect early recurrence after cytoreductive surgery and HIPEC for colorectal peritoneal Carcinomatosis. Ann Surg Oncol. 2015 Aug;22(8):2656–62.CrossRef
30.
Benoist S, Nordlinger B. The role of preoperative chemotherapy in patients with resectable colorectal liver metastases. Ann Surg Oncol. 2009 Sep;16(9):2385–90.CrossRef
31.
Schneider MA, Eden J, Pache B, Laminger F, Lopez-Lopez V, Steffen T, et al. Mutations of RAS/RAF proto-oncogenes impair survival after cytoreductive surgery and HIPEC for peritoneal metastasis of colorectal origin. Ann Surg. 2018 Nov;268(5):845–53.CrossRef
32.
Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009 Apr 2;360(14):1408–17.
Metadata
Title
Neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a feasibility and safety study
Authors
M. Leimkühler
P. H. J. Hemmer
A. K. L. Reyners
D. J. A. de Groot
R. J. van Ginkel
L. B. Been
G. H. de Bock
B. L. van Leeuwen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2019
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-018-1554-8

Other articles of this Issue 1/2019

World Journal of Surgical Oncology 1/2019 Go to the issue

Case report

Needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a report of two cases

Research

Immunologic cellular characteristics of the tumour microenvironment of hepatocellular carcinoma drive patient outcomes

Research

Mutational spectrum of tobacco associated oral squamous carcinoma and its therapeutic significance

Research

Is there a need for neoadjuvant short-course radiotherapy in T3 rectal cancer with positive lymph node involvement? A single-center retrospective cohort study

Case report

Repeat liver resection for pure large cell neuroendocrine carcinoma of the gallbladder: a favorable outcome

Research

Antiviral therapy predicts the outcomes following resection of hepatocellular carcinoma in patients negative for HBV DNA: a propensity score matching analysis