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The Role of Neoadjuvant and Adjuvant Systemic Chemotherapy with Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for colorectal peritoneal metastases (CPM), increasing overall survival in selected patients. The aim of this systematic review was to assess the effect of neoadjuvant and adjuvant systemic chemotherapy on overall survival in patients with CPM undergoing CRS and HIPEC, compared with those who receive CRS and HIPEC alone.

Methods

A systematic literature review was performed using the PubMed database, and the preferred reporting items for systematic reviews and meta-analyses guidelines formed the structure of the review. Data regarding publication details, study design, patient pathology, treatments received, follow-up periods, overall survival and safety were collected and tabulated, and study quality was assessed using the MINORS score for non-randomized studies.

Results

Sixteen of 288 studies met the inclusion criteria. Seven publications related to the role of neoadjuvant chemotherapy, and there was no strong evidence for the efficacy of neoadjuvant chemotherapy. Of note, one study observed worse survival outcomes when neoadjuvant therapy was used. Fourteen studies investigated the role of adjuvant chemotherapy and there was limited evidence that adjuvant systemic chemotherapy improves survival following CRS and HIPEC.

Conclusions

Systemic adjuvant chemotherapy may be associated with improved overall survival, but the role of systemic neoadjuvant chemotherapy cannot be determined by the currently available evidence. The delivery of a combination of the two modes of systemic chemotherapy has not been investigated in a randomized controlled trial to date. Further research designed to investigate the role of these modalities in the patient’s treatment is required.

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References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.1, cancer incidence and mortality worldwide: IARC CancerBase No. 11. 2014. http://globocan.iarc.fr. Accessed 11 Dec 2015.

  2. Lemmens VE, Klaver YL, Verwaal VJ, Rutten HJ, Coebergh JWW, de Hingh IH. Predictors and survival of synchronous peritoneal carcinomatosis of colorectal origin: a population-based study. Int J Cancer. 2011;128(11):2717–5.

    Article  CAS  PubMed  Google Scholar 

  3. Jayne DG, Fook S, Loi C, Seow‐Choen F. Peritoneal carcinomatosis from colorectal cancer. Br J Surg. 2002;89(12):1545–50.

    Article  CAS  PubMed  Google Scholar 

  4. Dawson LE, Russell AH, Tong D, Wisbeck WM. Adenocarcinoma of the sigmoid colon: sites of initial dissemination and clinical patterns of recurrence following surgery alone. J Surg Oncol. 1983;22(2):95–9.

    Article  CAS  PubMed  Google Scholar 

  5. Chu DZ, Lang NP, Thompson C, Osteen PK, Westbroo KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer. 1989;63(2):364–7.

    Article  Google Scholar 

  6. van Gestel YR, de Hingh IH, van Herk-Sukel MP, van Erning FN, Beerepoot LV, Wijsman JH, et al. Patterns of metachronous metastases after curative treatment of colorectal cancer. Cancer Epidemiol. 2014;38:448–54.

    Article  Google Scholar 

  7. Franko J, Shi Q, Goldman CD, Pockaj BA, Nelson GD, Goldberg RM, et al. Treatment of colorectal peritoneal carcinomatosis with systemic chemotherapy: a pooled analysis of North Central Cancer Treatment Group phase III trials N9741 and N9841. J Clin Oncol. 2012;30(3):263–7.

    Article  Google Scholar 

  8. Ceelen WP, Bracke ME. Peritoneal minimal residual disease in colorectal cancer: mechanisms, prevention, and treatment. Lancet Oncol. 2009;10:72–9.

    Article  Google Scholar 

  9. Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.

    Article  Google Scholar 

  10. Sugarbaker PH. Surgical management of carcinomatosis from colorectal cancer. Clin Colon Rectal Surg. 2005;18(3):190–203.

    Article  Google Scholar 

  11. Verwaal VJ, van Ruth S, de Bree E, van Slooten GW, van Tinteren H, Boot H, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol. 2003;21:3737–43.

    Article  Google Scholar 

  12. Mirnezami R, Mehta AM, Chandrakumaran K, Cecil T, Moran BJ, Verwaal C, et al. Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy. Br J Surg. 2014;111:1500–8.

    Google Scholar 

  13. PRISMA. PRISMA. 2015. http://prisma-statement.org/. Accessed 9 Oct 2015.

  14. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomised studies (MINORS): development and validation of a new instrument. Aust N Z J Surg. 2003;73:712–6.

    Article  Google Scholar 

  15. Gilly FN, International Registry of Colorectal Carcinomatosis. Phase II studies: International Registry of Colorectal Carcinomatosis. Eur J Surg Oncol. 2006;32(6):648–54.

    Article  Google Scholar 

  16. Glehen O, Cotte E, Schreiber V, Sayag‐Beaujard AC, Vignal J, Gilly FN. Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg. 2004;91:747–54.

    Article  Google Scholar 

  17. Glehen OF, Kwiatkowski PH, Sugarbaker D, Elias EA, Levine M, De Simone R. Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol. 2004;22(16):3284–92.

    Article  Google Scholar 

  18. Ceelen W, Van Nieuwenhove Y, Putte D, Pattyn P. Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis. Ann Surg Oncol. 2014;21:3023–8.

    Article  Google Scholar 

  19. Passot G, Vaudoyer D, Cotte E, You B, Isaac S, Gilly FN, et al. Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis. Ann Surg. 2012;256:125–9.

    Article  Google Scholar 

  20. Yonemura Y, Canbay E, Ishibashi H. Prognostic factors of peritoneal metastases from colorectal cancer following cytoreductive surgery and perioperative chemotherapy. Sci World J. 2013;2013:1–7.

    Article  Google Scholar 

  21. Elias D, Gilly F, Boutitie F, Quenet F, Bereder JM, Mansvelt B, et al. Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol. 2010;28(1):63–8.

    Article  Google Scholar 

  22. Elias D, Glehen O, Pocard M, Quenet F, Goéré D, Arvieux C, et al. A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg. 2010;251(5):896–901.

    Article  Google Scholar 

  23. Shen P, Hawksworth J, Lovato J, Loggie BW, Geisinger KR, Fleming RA, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol. 2004;11(2):178–86.

    Article  Google Scholar 

  24. Huang CQ, Yang XJ, Yu Y, Wu HT, Liu Y, Yonemura Y, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival for patients with peritoneal carcinomatosis from colorectal cancer: a phase II study from a Chinese center. PLoS ONE. 2012;9(9):e108509.

    Article  Google Scholar 

  25. Huang CQ, Feng JP, Yang XJ, Li Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from colorectal cancer: a case-control study from a Chinese center. J Surg Oncol. 2014;109:730–9.

    Article  Google Scholar 

  26. Adachi T, Hinoi T, Egi H, Shimomura M, Ohdan H. Oxaliplatin and molecular-targeted drug therapies improved the overall survival in colorectal cancer patients with synchronous peritoneal carcinomatosis undergoing incomplete cytoreductive surgery. Surg Today. 2015;45(8):986–92.

    Article  Google Scholar 

  27. Culliford AT, Brooks AD, Sharma S, Saltz LB, Schwartz GK, O’Reilly EM, et al. Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer. Ann Surg Oncol. 2001;8(10):787–95.

    Article  Google Scholar 

  28. Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995;221(2):124–32.

    Article  Google Scholar 

  29. Chua TC, Morris DL, Saxena A, Esquivel J, Liauw W, Doerfer J. Influence of modern systemic therapies as adjunct to cytoreduction and periopertive intraperitoneal chemotherapy for patient with colorectal peritoneal carcinomatosis: a multicenter study. Ann Surg Oncol. 2011;18:1560–7.

    Article  Google Scholar 

  30. Goéré D, Malka D, Tzanis D, Gava V, Boige V, Eveno C, et al. Is there a possibility of a cure in patients with colorectal peritoneal carcinomatosis amenable to complete cytoreductive surgery and intraperitoneal chemotherapy? Ann Surg. 2013;257(6):1065–71.

    Article  Google Scholar 

  31. Hompes D, Aalbers A, Boot H, Velthuysen ML, Vogel W, Prevoo W, et al. A prospective pilot study to assess neoadjuvant chemotherapy for unresectable peritoneal carcinomatosis from colorectal cancer. Colorectal Dis. 2014;16:O264–72.

    Article  Google Scholar 

  32. Klaver YL, de Hingh IH, Boot H, Verwaal VJ. Result of cytoreductive surgery and hyperthermic intraperitonal chemotherapy after early failure of adjuvant systemic chemotherapy. J Surg Oncol. 2011;103(5):431–4.

    Article  Google Scholar 

  33. Eveno C, Passot G, Goéré D, Soyer P, Gayat E, Glehen O, et al. Bevacizumab doubles the early postoperative complication rate after cytoreductive surger with hyperthermic intraperitonal chemotherapy (HIPEC) for peritoneal carcinomatosis of colorectal origin. Ann Surg Oncol. 2014;21:1792–800.

    Article  Google Scholar 

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Authors and Affiliations

  1. Good Hope Hospital, Heart of England NHS Foundation Trust, Birmingham, UK

    Kathryn Waite BSc, MBBS, MRCS & Haney Youssef MScR, FRCSEd (GenSurg)

Authors
  1. Kathryn Waite BSc, MBBS, MRCS
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  2. Haney Youssef MScR, FRCSEd (GenSurg)
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Correspondence to Haney Youssef MScR, FRCSEd (GenSurg).

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Waite, K., Youssef, H. The Role of Neoadjuvant and Adjuvant Systemic Chemotherapy with Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colorectal Peritoneal Metastases: A Systematic Review. Ann Surg Oncol 24, 705–720 (2017). https://doi.org/10.1245/s10434-016-5712-3

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  • DOI: https://doi.org/10.1245/s10434-016-5712-3

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