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Preoperative chemotherapy response and survival in patients with colorectal cancer peritoneal metastases
Tinsley, Nadina O'Dwyer, Sarah T Nagaraju, Raghavendar Chakrabarty, Bipasha Braun, Michael Mullamitha, Saifee Kamposioras, Konstantinos Marti-Marti, Francisca Saunders, Mark Clouston, Hamish
Tinsley, Nadina
O'Dwyer, Sarah T
Nagaraju, Raghavendar
Chakrabarty, Bipasha
Braun, Michael
Mullamitha, Saifee
Kamposioras, Konstantinos
Marti-Marti, Francisca
Saunders, Mark
Clouston, Hamish
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Abstract
Treatment guidelines provided by PRODIGE-7 recommend perioperative systemic chemotherapy before cytoreductive surgery (CRS) for colorectal cancer peritoneal metastases (CRPM). Toxicity with multimodal treatment needs to be better defined. Chemotherapy response and impact on survival have not been reported. We assessed CRPM patients who received systemic oxaliplatin/irinotecan before CRS (preoperative) with Mitomycin C (35 mg/m2, 90 min) or Oxaliplatin (368 mg/m2, 30 min) heated intraperitoneal chemotherapy (HIPEC). Secondary analysis was performed from a prospective database. Overall survival (OS) in chemotherapy responders (R) and nonresponders (NR) was compared. Toxicity was assessed by rate of adverse events (AEs). From April 2005 to April 2021, 436 patients underwent CRS + HIPEC; 125 (29%) received preoperative chemotherapy. The 112 (90%) received oxaliplatin (64, 57%) or irinotecan (48, 43%). R, defined as complete (CR) or partial response on preoperative imaging and/or postoperative histology, was seen in 71, 63% (53.8-72.3); 16, 14% (8.4-22.2) had CR. Median OS in R versus NR was 43.7 months (37.9-49.4) versus 23.9 (16.3-31.4) p = 0.007, HR 0.51 (0.31-0.84). OS multivariable analysis showed HR 0.48 (0.25-0.95), p = 0.03 for chemotherapy response corrected by peritoneal cancer index, completeness of cytoreduction score. CRS led to 21% grade 3-4 AEs versus 4% for preoperative chemotherapy. HIPEC grade 3-4 AEs were 0.5%. Preoperative chemotherapy response is an independent predictor for OS in CRPM. Perioperative chemotherapy is used in the multimodal treatment of colorectal cancer peritoneal metastases (CRPM). Preoperative chemotherapy response is an independent predictor for overall survival in patients with CRPM. Grade 3-4 adverse events related to mitomycin C (35 mg/m2) and Oxaliplatin (368 mg/m2) heated intraperitoneal chemotherapy are rare (0.5%).
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2024
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Tinsley N, O'Dwyer ST, Nagaraju R, Chakrabarty B, Braun M, Mullamitha S, et al. Preoperative chemotherapy response and survival in patients with colorectal cancer peritoneal metastases. JOURNAL OF SURGICAL ONCOLOGY. 2024 2024 JUL 16. PubMed PMID: WOS:001271076200001. English.