TREATMENT OF COLORECTAL CARCINOMATOSIS 

NEW YORK (Reuters Health) Jun 07 - Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) from colorectal cancer can be undertaken with a curative intent even if neoadjuvant systemic chemotherapy was unsuccessful, European researchers say.

Some institutions consider progression despite neoadjuvant therapy to be an absolute contraindication to surgery and HIPEC, the researchers said in their May 10th online paper in the Annals of Surgery.

"If PC is considered to be locoregional disease spread, response to systemic chemotherapy might differ to that of visceral metastases," wrote senior investigator Dr. Glehen Olivier of Centre Hospitalo-Universitaire Lyon Sud, France and colleagues.

The team studied data on 120 patients who underwent 131 combined cytoreductive surgery and HIPEC procedures.

Ninety patients had received neoadjuvant systemic chemotherapy. Responses could not be evaluated in 20 patients (22%). Of the remaining 70, 32 (36%) responded, 19 (21%) had stable disease, and 19 (21%) developed disease progression.

On univariate analysis, the use of neoadjuvant systemic chemotherapy had a significant positive prognostic influence. However, on multivariate analysis the completeness of cytoreductive surgery and the use of adjuvant systemic chemotherapy were the only significant prognostic factors.

Median overall survival was 36.2 months. One-year survival was 77%; five-year survival was 33%. Patients with progressive disease had a median survival of 31.4 months, a one-year survival rate of 75%, and a five-year rate of 26%. Patients with a response or stable disease did better, with a median survival of more than 50 months and a five-year survival rate of more than 50%.

Nevertheless, the researchers say their findings in the nonresponders are encouraging, and "failure of neoadjuvant systemic chemotherapy in patients with PC from colorectal cancer, with no extraperitoneal disease, should not constitute an absolute contraindication to a curative procedure combining cytoreductive surgery and HIPEC."

Dr. Olivier did not respond to requests for comments.