A Total Neoadjuvant Chemotherapy Approach is Associated with Improved Recurrence-free Survival in Patients with Colorectal Peritoneal Metastases Undergoing Cytoreductive Surgery and HIPEC

Overview

Journal J Surg Oncol

Specialties General Surgery
Oncology

Date 2022 Nov 9

PMID 36350108

Authors

David N Hanna

Rebekah Macfie

Muhammad O Ghani

Andrew Hermina

Alexander Mina

Da Eun Cha

Christina E Bailey

Noah Cohen

Daniel Labow

Benjamin Golas

Umut Sarpel

Deepa Magge

Kamran Idrees

Affiliations

Soon will be listed here.

Abstract

Background: The primary aim of this study is to evaluate the oncologic outcomes of two popular systemic chemotherapy approaches in patients with colorectal peritoneal metastases (CPM) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).

Methods: We performed a dual-center retrospective review of consecutive patients who underwent CRS-HIPEC for CPM due to high or intermediate-grade colorectal cancer. Patients in the total neoadjuvant therapy (TNT) group received 6 months of preoperative chemotherapy. Patients in the "sandwich" (SAND) chemotherapy group received 3 months of preoperative chemotherapy with a maximum of 3 months of postoperative chemotherapy.

Results: A total of 34 (43%) patients were included in the TNT group and 45 (57%) patients in the SAND group. The median overall survival (OS) in the TNT and SAND groups were 77 and 61 months, respectively (p = 0.8). Patients in the TNT group had significantly longer recurrence-free survival (RFS) than the SAND group (29 vs. 12 months, p = 0.02). In a multivariable analysis, the TNT approach was independently associated with improved RFS.

Conclusion: In this retrospective study, a TNT approach was associated with improved RFS, but not OS when compared with a SAND approach. Further prospective studies are needed to examine these systemic chemotherapeutic approaches in patients with CPM undergoing CRS-HIPEC.

Citing Articles

Neoadjuvant chemotherapy does not improve survival for patients with high volume colorectal peritoneal metastases undergoing cytoreductive surgery.

Sarofim M, Wijayawardana R, Ahmadi N, Barat S, Liauw W, Morris D World J Surg Oncol. 2024; 22(1):103.

PMID: 38637820 PMC: 11025186. DOI: 10.1186/s12957-024-03392-8.

Systemic Chemotherapy in Colorectal Peritoneal Metastases Treated with Cytoreductive Surgery: Systematic Review and Meta-Analysis.

Tonello M, Cenzi C, Pizzolato E, Fiscon R, Del Bianco P, Pilati P Cancers (Basel). 2024; 16(6).

PMID: 38539516 PMC: 10969605. DOI: 10.3390/cancers16061182.

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