Neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: a feasibility and safety study

• Published in: World journal of surgical oncology Vol. 17; no. 1; p. 14
• Main Authors: Leimkühler, M, Hemmer, P H J, Reyners, A K L, de Groot, D J A, van Ginkel, R J, Been, L B, de Bock, G H, van Leeuwen, B L
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.01.2019; BioMed Central; BMC
• Subjects: Adjuvant chemotherapy; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biopsy; Cancer metastasis; Cancer research; Cancer therapies; Cancer treatment; Carcinoma; Care and treatment; CAT scans; Chemotherapy; Chemotherapy, Adjuvant; Chemotherapy, Cancer, Regional Perfusion; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy; Complications; Computed tomography; Cytoreduction Surgical Procedures; Debulking; Feasibility Studies; Female; Follow-Up Studies; Gastric cancer; HIPEC; Humans; Hyperthermia, Induced; Liver; Male; Medical research; Metastases; Metastasis; Middle Aged; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Oxaliplatin; Patients; Peritoneal carcinomatosis; Peritoneal Neoplasms - pathology; Peritoneal Neoplasms - therapy; Peritoneum; Postoperative complications; Prognosis; Safety; Surgery; Surgical outcomes; Survival Rate; Tomography; Toxicity; Tumors; Neoadjuvant chemotherapy; HIPEC; Colorectal cancer; Peritoneal carcinomatosis
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-018-1554-8

Standard treatment for colorectal peritoneal carcinomatosis typically involves cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and if possible, postoperative adjuvant chemotherapy. However, a substantial percentage of patients never receive adjuvant chemotherapy because of postoperative complications. Neoadjuvant chemotherapy could be beneficial in this setting, so we assessed its feasibility and safety when used before cytoreductive surgery and HIPEC. In this non-randomized, single-center, observational feasibility study, patients were scheduled to receive six cycles of capecitabine and oxaliplatin before cytoreductive surgery and HIPEC. Computed tomography was performed after the third and sixth chemotherapy cycles to evaluate tumor response, and patients underwent cytoreductive surgery and HIPEC if there were no pulmonary and/or hepatic metastases. Postoperative complications, graded according to the Clavien-Dindo classification, were compared with those of a historic control group that received postoperative adjuvant chemotherapy. Of the 14 patients included in the study, 4 and 3 had to terminate neoadjuvant chemotherapy early because of toxicity and tumor progression, respectively. Cytoreductive surgery and HIPEC were performed in eight patients, and the timing and severity of complications were comparable to those of patients in the historic control group treated without neoadjuvant chemotherapy. Patients with peritoneal metastases due to colorectal carcinoma can be treated safely with neoadjuvant chemotherapy before definitive therapy with cytoreductive surgery and HIPEC. NTR 3905, registered on 20th march, 2013, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3905.