Surgery-chemotherapy combo can improve survival in peritoneal carcinomatosis

Cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy with mitomycin C can improve the outcomes of patients with peritoneal carcinomatosis from nonappendiceal colorectal cancer. Together with other reports, the findings suggest that “selected patients can achieve long-term survival with complete removal of peritoneal disease from colorectal cancer,” lead investigator Dr. Perry Shen said in a statement.

The results are based on a study of 77 patients who were treated with cytoreductive surgery (CS) with intraperitoneal hyperthermic chemotherapy (IPHC) at Wake Forest University in Winston-Salem, North Carolina, by Dr. Shen and colleagues between December 1991 and April 2002. The researchers’ findings are published in the February issue of the Annals of Surgical Oncology.The median patient age was 54 years. Most had metachronous peritoneal carcinomatosis and most had received chemotherapy before being treated with IPHC. Complete removal of all gross disease was achieved in 37 patients.CS-IPHC was associated with a significant drop in mean CEA level, from 31.2 preoperatively to 6.9 after surgery, the researchers note. In the entire study group, overall 5-year survival was 17% with a median survival period of 16 months. With complete resection of gross disease, however, the corresponding figures were improved to 34% and 28 months.On regression analysis, poor performance status, bowel obstruction, malignant ascites, and incomplete resection of gross disease were identified as predictors of decreased survival after CS-IPHC.Perioperative morbidity and mortality rates were 30% and 12%, respectively, the authors note. In addition, hematologic toxicity was observed in 15 patients (19%).Although CS-IPHC is “not a treatment for all patients with peritoneal cancer, selected patients may benefit from improved quality of life and extended survival,” Dr. Shen noted. Still, “multicenter trials are needed to confirm” the findings, the researchers add.(Source: Ann Surg Oncol 2004;11:178-186: Reuters Health: March 2004: Oncolink)