title: A prospective pilot study to assess neoadjuvant chemotherapy for unresectable peritoneal carcinomatosis from colorectal cancer.
abstract: OBJECTIVE
  Twelve to 13% of patients with colorectal cancer (CRC) develop peritoneal carcinomatosis (PC), the majority of whom present with unresectable disease. This study aimed to document the actual response rate to and response characteristics of preoperative modern systemic chemotherapy in this patient group.
  
  
  METHODS
  Patients underwent a positron emission tomography (PET)/CT scan, laparoscopy and peritoneal biopsy to document unresectable PC. After four courses of preoperative chemotherapy (capecitabine/oxaliplatin ± bevacizumab), the extent of PC was re-evaluated by PET/CT(or CT), laparoscopy and peritoneal biopsy (if considered safe).
  
  
  RESULTS
  Ten patients (seven men, three women) with good performance status of median age 60.3 (45.6-72.8) years were studied. The first laparoscopy documented unresectable PC. One patient was excluded because of systemic metastases on PET/CT. Nine proceeded to follow the trial protocol. Of these, one developed early progressive disease, two had macroscopically stable disease and five had progressive disease at second laparoscopy. One patient developed a small bowel perforation at first laparoscopy and received palliative chemotherapy outside the protocol, after which progressive disease was found at an explorative laparotomy. Thus, 7 (78%) patients with unresectable PC from CRC developed progressive disease under neoadjuvant chemotherapy and 2 (22%) patients remained stable. No clear macroscopic response to chemotherapy could be demonstrated.
  
  
  CONCLUSIONS
  Unresectable PC from CRC does not respond well to systemic chemotherapy.
authors.affiliation: Department of Surgical Oncology, Antoni van Leeuwenhoek-Hospital/the Netherlands Cancer Institute, Amsterdam, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Hompes
authors.forename: A
authors.initials: A
authors.lastname: Aalbers
authors.forename: H
authors.initials: H
authors.lastname: Boot
authors.forename: M-L
authors.initials: ML
authors.lastname: van Velthuysen
authors.forename: W
authors.initials: W
authors.lastname: Vogel
authors.forename: W
authors.initials: W
authors.lastname: Prevoo
authors.forename: H
authors.initials: H
authors.lastname: van Tinteren
authors.forename: V
authors.initials: V
authors.lastname: Verwaal
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab; D000069287:Capecitabine; D002272:Carcinoembryonic Antigen / Q000097:blood; D002277:Carcinoma / Q000097:blood / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000556:secondary*; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D002272:Carcinoembryonic Antigen; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D000068258:Bevacizumab; D000069287:Capecitabine; D005472:Fluorouracil
keywords: Peritoneal carcinomatosis; colorectal cancer; neoadjuvant chemotherapy; response; unresectable