title: Progression following neoadjuvant systemic chemotherapy may not be a contraindication to a curative approach for colorectal carcinomatosis.
abstract: OBJECTIVE
  The objective of this retrospective study was to evaluate the influence of neoadjuvant systemic chemotherapy on patients with colorectal carcinomatosis before a curative procedure.
  
  
  BACKGROUND
  Peritoneal carcinomatosis (PC) from colorectal cancer may be treated with a curative intent by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The role of perioperative systemic chemotherapy for this particular metastatic disease remains unclear.
  
  
  METHODS
  One hundred twenty patients with PC from colorectal cancer were consecutively treated by 131 procedures combining CRS with HIPEC. The response to neoadjuvant systemic chemotherapy was assessed on data from previous explorative surgery and/or radiological imaging.
  
  
  RESULTS
  Ninety patients (75%) were treated with neoadjuvant systemic chemotherapy in whom 32 (36%) were considered to have responded, 19 (21%) had stable disease, and 19 (21%) developed diseases progression. Response could not be evaluated in 20 patients (22%). On univariate analysis, the use of neoadjuvant systemic chemotherapy had a significant positive prognostic influence (P = 0.042). On multivariate analysis, the completeness of CRS and the use of adjuvant systemic chemotherapy were the only significant prognostic factors (P < 0.001 and P = 0.049, respectively). Response to neoadjuvant systemic chemotherapy had no significant prognostic impact with median survival of 31.4 months in patients showing disease progression.
  
  
  CONCLUSIONS
  In patients with PC from colorectal cancer without extraperitoneal metastases, failure of neoadjuvant systemic chemotherapy should not constitute an absolute contraindication to a curative procedure combining CRS and HIPEC.
authors.affiliation: Surgical Oncology Department, Centre Hospitalo-Universitaire Lyon Sud, Pierre Bénite, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.forename: Delphine
authors.initials: D
authors.lastname: Vaudoyer
authors.forename: Eddy
authors.initials: E
authors.lastname: Cotte
authors.forename: Benoit
authors.initials: B
authors.lastname: You
authors.forename: Sylvie
authors.initials: S
authors.lastname: Isaac
authors.forename: François
authors.initials: F
authors.lastname: Noël Gilly
authors.forename: Faheez
authors.initials: F
authors.lastname: Mohamed
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000075202:Contraindications; D018450:Disease Progression; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult