Surgical cytoreduction in patients with colorectal peritoneal carcinomatosis treated with contemporary chemotherapy.

Abstract

3546 Background: In the setting of contemporary chemotherapy (CH) regimens there are limited data evaluating cytoreductive surgery (CRS) and outcomes of patients with colorectal adenocarcinoma (CRC) and isolated peritoneal surface disease (PSD). Methods: A retrospective review of a single-cancer center experience in the management of CRC and PSD was performed. Cases with PSD diagnosed between 1998 and 2007 were identified from an institutional database and medical records were reviewed. Patients with appendiceal carcinoma, concurrent metastasis to other sites (e.g., liver, retroperitoneum), or second malignancies were excluded. The role of CRS to microscopic disease only (CC0), used selectively, was analyzed with overall survival (OS) as the primary endpoint. Results: Of 8,052 patients with CRC, 686 (8.5%) were found to have PSD and 214 (2.7%) had isolated PSD. Of these 151 received FOLFOX or FOLFIRI with or without a biologic agent for metastatic CRC. Of these, 35 (23.2%) had a CC0 resection. Of the remaining 116 (76.8%) patients, surgical procedures were used selectively for palliation. The median follow up at the institution was 21.2 months. 93.8% of treatment was delivered at the cancer center. There was no difference between the CC0 and non-CC0 patients with respect to gender, age, comorbidities, performance status, previous exposure to CH, histology, stage at presentation, and burden of PSD. Ascites was less frequent in the CC0 group (11.4% vs. 33.3% p = 0.02). During the follow up period 76.2% of patients were admitted to an inpatient service and 38.4% had a bowel obstruction (BO). CC0 patients had delayed presentation with BO (median time to BO 53.1 vs. 31.5 months, p = 0.02). CC0 was associated with longer OS (median 31.6 vs. 20.3 months, p = 0.003). Index PSD CEA, index PSD albumin, stage IV presentation, burden of PSD, achievement of CC0, and having received biological agents in any combination were independently associated with OS. Conclusions: CRC with isolated PSD is rare and major morbidity related to it is high. Among patients treated with contemporary CH, patients in whom CC0 resection was achieved had a median OS of 31.6 months compared to 20.3 months in whom CC0 resection was not achieved. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Alchemia, Biothera, Delcath, ImClone Systems, Merck, Novartis, Roche Pfizer Amgen, Biothera, Bristol-Myers Squibb, Curetech, Genentech, ImClone Systems, Lilly, Merck, Pfizer, Roche, Tercica