Abstract
BackgroundWe evaluate the long-term survival of patients with peritoneal carcinomatosis (PC) treated with systemic chemotherapy regimens, and the impact of the of the retrospective peritoneal disease severity score (PSDSS) on outcomes.MethodsOne hundred sixty-seven consecutive patients treated with PC from colorectal cancer between years 1987-2006 were identified from a prospective institutional database. These patients either received no chemotherapy, 5-FU/Leucovorin or Oxaliplatin/Irinotecan-based chemotherapy. Stratification was made according to the retrospective PSDSS that classifies PC patients based on clinically relevant factors. Survival analysis was performed using the Kaplan-Meier method and comparison with the log-rank test.ResultsMedian survival was 5 months (95% CI, 3-7 months) for patients who had no chemotherapy, 11 months (95% CI, 6-9 months) for patients treated with 5 FU/LV, and 12 months (95% CI, 4-20 months) for patients treated with Oxaliplatin/Irinotecan-based chemotherapy. Survival differed between patients treated with chemotherapy compared to those patients who did not receive chemotherapy (p = 0.026). PSDSS staging was identified as an independent predictor for survival on multivariate analysis [RR 2.8 (95%CI 1.5-5.4); p < 0.001].ConclusionA trend towards improved outcomes is demonstrated from treatment of patients with PC from colorectal cancer using modern systemic chemotherapy. The PSDSS appears to be a useful tool in patient selection and prognostication in PC of colorectal origin.
Highlights
We evaluate the long-term survival of patients with peritoneal carcinomatosis (PC) treated with systemic chemotherapy regimens, and the impact of the of the retrospective peritoneal disease severity score (PSDSS) on outcomes
To evaluate the effectiveness of systemic chemotherapy, we report the results of a single institution experience of systemic chemotherapy for PC from colorectal cancer with stratification according to the peritoneal surface disease severity score (PSDSS) to elucidate stage-specific outcomes that may guide clinical treatment decision for patient-specific delivery of therapy
Phase II studies have demonstrated that Cytoreductive surgery (CS) combined with hyperthermic intraperitoneal chemoperfusion (HIPEC) is associated with an improved survival in patients with limited PC amenable to complete cytoreduction when compared to historical controls which were treated palliatively with systemic chemotherapy alone [14]
Summary
We evaluate the long-term survival of patients with peritoneal carcinomatosis (PC) treated with systemic chemotherapy regimens, and the impact of the of the retrospective peritoneal disease severity score (PSDSS) on outcomes. The difficulties of including these patients are a result of the inability to image sub-centimetre peritoneal lesions and assess tumor response on the RECIST criteria. Strictly speaking, this leaves this subgroup of patients with Stage IV colorectal cancer without any appreciable evidence of disease and the treatment response cannot be documented or monitored
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