Impact of Neoadjuvant Chemotherapy on the Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Multi-Institutional Retrospective Review

• Authors: Eliza W Beal, Ohio State University; Lorena P Suarez-Kelly, Ohio State University; Charles W Kimbrough, Ohio State University; Fabian M Johnston, Johns Hopkins University; Jonathan Greer, Johns Hopkins University; Daniel E Abbott, University of Wisconsin, Madison; Courtney Pokrzywa, University of Wisconsin, Madison; Mustafa Raoof, City of Hope National Medical Center; Byrne Lee, City of Hope National Medical Center; Travis E Grotz, Mayo Clinic; Jennifer L Leiting, Mayo Clinic; Keith Fournier, University of Texas MD Anderson Cancer Center, Houston; Andrew J Lee, University of Texas MD Anderson Cancer Center, Houston; Sean P Dineen, H Lee Moffitt Cancer Centre & Research Institute; Benjamin Powers, H Lee Moffitt Cancer Centre & Research Institute; Jula Veerapong, University of California San Diego; Joel M Baumgartner, University of California San Diego; Callisia Clarke, Medical College of Wisconsin, Milkwaukee; Harveshp Mogal, Medical College of Wisconsin, Milkwaukee; Marti C Russell, Emory University; Mohammed Y Zaidi, Emory University; Sameer H Patel, University of Cincinnati; Vikrom Dhar, University of Cincinnati; Laura Lambert, University of Massachusetts Memorial Medical Center, Worcester; Ryan J Hendrix, University of Massachusetts Memorial Medical Center, Worcester; John Hays, Ohio State University; Sherif Abdel-Misih, Ohio State University; Jordan M Cloyd, Ohio State University
• Journal Title: JOURNAL OF CLINICAL MEDICINE
• Volume: Volume 9, Number 3
• Publisher: MDPI | 2020-03-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/jcm9030748
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, General & Internal; General & Internal Medicine; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; colorectal peritoneal metastases; SYSTEMIC CHEMOTHERAPY; CARCINOMATOSIS; CANCER; SURVIVAL; TRIALS; HIPEC; CHEMOPERFUSION; COMPLICATIONS; BEVACIZUMAB

Abstract

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000–2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.