Peritoneal carcinomatosis index predicts survival in colorectal patients undergoing HIPEC using oxaliplatin: a retrospective single-arm cohort study

Alexis-Simon Cloutier,Lucas Sideris,Nora Trabulsi,Mai-Kim Gervais,Atuhani Burnett,Pierre Dubé,Marie-Eve Aubé Lecompte,Bertrand Trilling

doi:10.1186/s12957-019-1618-4

Abstract

BackgroundPeritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for patients with colorectal peritoneal carcinomatosis. However, standardization of HIPEC protocols, including which chemotherapeutic agent to use, is lacking in the literature. Therefore, we sought to report survival outcomes from colorectal cancer patients undergoing CRS/oxaliplatin-based HIPEC at our institution over the last 10 years.MethodsColorectal PC patients treated with CRS/oxaliplatin-based HIPEC 2004–2015 were included. Demographic, clinical, and oncologic data were abstracted from the medical record. Overall (OS) and disease-free survival (DFS) were calculated using Kaplan–Meier analysis. Univariate/multivariate Cox regression analysis was done.ResultsLaparotomy was performed in 113 patients for colorectal PC; 91 completed a curative intent CRS/HIPEC. At 3 and 5 years, OS for the CRS/HIPEC cohort was 75% and 55%, and DFS was 50% and 25%, respectively. On multivariate analysis, incremental increases in peritoneal carcinomatosis index (PCI) were associated with worse OS (p = 0.0001) and DFS (p = 0.0001). Grade III/IV complications were also associated with worse OS.ConclusionsA standardized regimen of CRS and oxaliplatin-based HIPEC for colorectal PC is effective with favorable OS and DFS and acceptable complication rates.

Highlights

Peritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis
hyperthermic intraperitoneal chemotherapy (HIPEC); Verwaal et al showed in their landmark randomized trial from the Netherlands that colorectal PC treated with Cytoreductive surgery (CRS)/HIPEC using mitomycin C had a median survival of 22.2 months compared to 12.6 months when treated with chemotherapy alone [5, 6]
Multiple retrospective studies, such as Elias et al, subsequently demonstrated an improved 5-year overall survival of 51% when PC was treated with CRS/HIPEC compared with 13% when these patients were treated with chemotherapy alone [3]

Summary

Introduction

Peritoneal carcinomatosis (PC) from colorectal cancer is associated with poor prognosis. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has improved survival for patients with colorectal peritoneal carcinomatosis. HIPEC; Verwaal et al showed in their landmark randomized trial from the Netherlands that colorectal PC treated with CRS/HIPEC using mitomycin C had a median survival of 22.2 months compared to 12.6 months when treated with chemotherapy alone [5, 6]. Multiple retrospective studies, such as Elias et al, subsequently demonstrated an improved 5-year overall survival of 51% when PC was treated with CRS/HIPEC compared with 13% when these patients were treated with chemotherapy alone [3]. A curative intent complete cytoreduction combined with HIPEC is considered the standard of care for PC of colorectal origin with an expected long-term survival of 40% at 5 years [7]

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Results

Discussion

Conclusion