Originally published as JCO Early Release 10.1200/JCO.2008.19.7160 on December 22 2008

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Complete Cytoreductive Surgery Plus Intraperitoneal Chemohyperthermia With Oxaliplatin for Peritoneal Carcinomatosis of Colorectal Origin

From the Department of Oncologic Surgery and the Health Economics Department, Institut Gustave Roussy, Villejuif; Department of Surgery, Institut Alexis-Vautrin, Vandoeuvre-lès-Nancy; Department of Oncologic Surgery, Institut René-Gauducheau, Nantes; Department of Surgical Oncology, Institut Claudius Regaud, Toulouse; Department of Surgical Oncology, Institut Francois Baclesse, Caen; and Department of Surgical Oncology, Institut Leon Bérard, Lyon, France.

Corresponding author: Dominique Elias, MD, PhD, Département de Chirurgie Carcinologique, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France; e-mail: elias{at}igr.fr.

Purpose To compare the long-term survival of patients with isolated and resectable peritoneal carcinomatosis (PC) in comparable groups of patients treated with systemic chemotherapy containing oxaliplatin or irinotecan or by cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC).

Patients and Methods All patients with gross PC from colorectal adenocarcinoma who had undergone cytoreductive surgery plus HIPEC from 1998 to 2003 were evaluated. The standard group was constituted by selecting patients with colorectal PC treated with palliative chemotherapy during the same period, but who had not benefited from HIPEC because the technique was unavailable in the center at that time.

Results Forty-eight patients were retrospectively included in the standard group and were compared with 48 patients who had undergone HIPEC and were evaluated prospectively. All characteristics were comparable except age and tumor differentiation. There was no difference in systemic chemotherapy, with a mean of 2.3 lines per patient. Median follow-up was 95.7 months in the standard group versus 63 months in the HIPEC group. Two-year and 5-year overall survival rates were 81% and 51% for the HIPEC group, respectively, and 65% and 13% for the standard group, respectively. Median survival was 23.9 months in the standard group versus 62.7 months in the HIPEC group (P < .05, log-rank test).

Conclusion Patients with isolated, resectable PC achieve a median survival of 24 months with modern chemotherapies, but only surgical cytoreduction plus HIPEC is able to prolong median survival to roughly 63 months, with a 5-year survival rate of 51%.

Supported in part with French Government funding from the program "Technological support to expensive innovations."

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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