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Title: Surgical Treatment Can Provide Good Outcomes for Isolated Metastases of Colorectal Cancer to the Liver or Peritoneum: Presented at SSO

"Surgical Treatment Can Provide Good Outcomes for Isolated Metastases of Colorectal Cancer to the Liver or Peritoneum: Presented at SSO"

By Mary Beth Nierengarten CHICAGO -- March 19, 2008 -- Surgical treatment for isolated peritoneal carcinomatosis (PC) should be considered a viable option for selected patients with colorectal cancer, according to a study reported here at the Society of Surgical Oncology (SSO) 61st Annual Cancer Symposium. Patients with PC treated with cytoreduction and intraperitoneal hyperthermic chemotherapy (IPHC) achieved survival rates similar to those achieved by patients who underwent surgical treatment for isolated hepatic metastases from colorectal cancer, the investigators reported during a session on March 14. Currently, surgery is the treatment of choice for isolated hepatic disease from colorectal metastases, but treatment for PC from colorectal cancer is still not well defined. Recently, cytoreduction and IPHC have been used with an associated median survival time of 42 months. To date, however, there is no consensus among oncologists on the role, timing, or efficacy of this treatment for patients with PC. "The rationale for cytoreduction and IPHC is based on the fact that PC occurs by direct extension, and treatment of this presentation may prevent further dissemination," said lead author of the study, Perry Shen, MD, Assistant Professor of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina. "[IPHC] has been shown to increase drug exposure at the site of application in the peritoneum." To evaluate the efficacy of this treatment approach for PC, Dr. Shen and colleagues evaluated outcomes of 121 patients with colorectal cancer who underwent cytoreduction and IPHC for isolated PC between 1992 and 2005, and compared these with outcomes of 101 patients with colorectal cancer who underwent liver resection for isolated hepatic metastases between 1994 and 2005. Median follow-up times for the 2 groups were 55 and 37 months, respectively. Of the 121 patients treated for PC, 46% had complete resection of all gross tumours with either negative margins (R0, n = 31) or positive microscopic margins (R1, n = 26), Dr. Shen said. In the patients with liver metastases, 95 patients had negative margins, 4 had positive margins, and data were not available for 2 patients. Results showed similar overall survival rates in the PC and hepatic groups, respectively, at 1 year (90.3% vs 86.5%), 3 years (49.9% vs 58.0%), and 5 years (30.0% vs 39.7%) ([P = .51 for all). In addition, no difference was found between the groups in perioperative morbidity (45.6% vs 41.0%, P = .62) or mortality (5.3% vs 5.0%, P = .93).

Based on these data, Dr. Shen recommended that "isolated PC disease from colorectal carcinoma should be considered in a similar paradigm as hepatic metastases."

Although the role of IPHC and how much it adds to outcomes is still an unanswered question, Dr. Shen said multiple studies of cytoreduction and IPHC have shown that cytoreduction is the most important aspect of treatment and that if gross disease is left behind, these patients will not benefit, even with IPHC.

[Presentation title: Isolated Metastases of Colorectal Cancer to the Liver or Peritoneum: Outcomes Associated With Optimal Surgical Treatment. Abstract 12]

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