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


METHODS
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.


RESULTS
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.


CONCLUSION
Patients with peritoneal metastases due to colorectal carcinoma can be treated safely with neoadjuvant chemotherapy before definitive therapy with cytoreductive surgery and HIPEC.


TRIAL REGISTRATION NUMBER
NTR 3905, registered on 20th march, 2013, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3905.
['Leimkühler|M|M|', 'Hemmer|P H J|PHJ|', 'Reyners|A K L|AKL|', 'de Groot|D J A|DJA|', 'van Ginkel|R J|RJ|', 'Been|L B|LB|', 'de Bock|G H|GH|', 'van Leeuwen|B L|BL|']
D000328:Adult D000368:Aged D000971:Antineoplastic Combined Chemotherapy Protocols D017024:Chemotherapy, Adjuvant D010478:Chemotherapy, Cancer, Regional Perfusion D015179:Colorectal Neoplasms D003131:Combined Modality Therapy D065426:Cytoreduction Surgical Procedures D005240:Feasibility Studies D005260:Female D005500:Follow-Up Studies D006801:Humans D006979:Hyperthermia, Induced D008297:Male D008875:Middle Aged D020360:Neoadjuvant Therapy D010534:Peritoneal Neoplasms D011379:Prognosis D015996:Survival Rate
Neoadjuvant chemotherapy Colorectal cancer Peritoneal carcinomatosis HIPEC