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

Autor: Beal EW; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA., Suarez-Kelly LP; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA., Kimbrough CW; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA., Johnston FM; Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD 21205, USA., Greer J; Department of Surgery, Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD 21205, USA., Abbott DE; Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792, USA., Pokrzywa C; Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI 53792, USA., Raoof M; Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA., Lee B; Department of Surgery, Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA., Grotz TE; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA., Leiting JL; Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN 55905, USA., Fournier K; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 44907, USA., Lee AJ; Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 44907, USA., Dineen SP; Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, FL 33612, USA., Powers B; Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, FL 33612, USA., Veerapong J; Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, CA 92093, USA., Baumgartner JM; Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego, CA 92093, USA., Clarke C; Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milkwaukee, WI 53226, USA., Mogal H; Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milkwaukee, WI 53226, USA., Russell MC; Winship Cancer Institute, Division of Surgical Oncology, Emory University, Atlanta, GA 30322, USA., Zaidi MY; Winship Cancer Institute, Division of Surgical Oncology, Emory University, Atlanta, GA 30322, USA., Patel SH; Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA., Dhar V; Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA., Lambert L; Department of Surgery, Division of Surgical Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA 45219, USA., Hendrix RJ; Department of Surgery, Division of Surgical Oncology, University of Massachusetts Memorial Medical Center, Worcester, MA 45219, USA., Hays J; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA., Abdel-Misih S; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA., Cloyd JM; Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH 43201, USA.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2020 Mar 10; Vol. 9 (3). Date of Electronic Publication: 2020 Mar 10.
DOI: 10.3390/jcm9030748
Abstrakt: 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.
Databáze: MEDLINE
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