title: Early Postoperative Chemotherapy After Complete Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Isolated Peritoneal Carcinomatosis of Colon Cancer: A Multicenter Study.
abstract: OBJECTIVE
  The prognosis of peritoneal carcinomatosis (PC) from colorectal cancer has been improved with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, benefits of postoperative chemotherapy (CT) are unclear.
  
  
  METHODS
  This retrospective, multicenter study included 231 patients treated by CRS and HIPEC for isolated PC of colon cancer in four expert's centers. Overall survival (OS), progression-free survival (PFS), and peritoneal recurrence-free survival (PRFS) were compared between patients with adjuvant CT (started within 3 months after surgery) and patients with surveillance only.
  
  
  RESULTS
  After exclusion of 10 patients for early postoperative death (4%), 221 patients were included (CT group: n = 151; surveillance group: n = 70). Main postoperative CT regimens (median of 6 cycles) were Folfox (28%), Folfiri bevacizumab (24.5%), Folfiri (16%), and Folfiri cetuximab (12.5%). The median OS after surgery was 43.3 months with no difference between CT and surveillance groups. In multivariate analysis, a low peritoneal cancer index (p < 0.0001) and a long delay between diagnosis of CP and HIPEC (p = 0.001) were associated with increased OS. The median PFS and PRFS were 12.4 and 17 months, respectively. At 1 year, more patients were without progression (p = 0.001) or PC recurrence (0.0004) in the CT group, but with prolonged follow-up this difference was no longer significant.
  
  
  CONCLUSIONS
  Early postoperative CT does not improve OS after CRS and HIPEC for colon carcinomatosis. However, a transient effect on PFS and PRFS was observed. A subgroup of patients who may benefit more from CT remain to be defined.
authors.affiliation: Department of Gastroenterology, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Maillet
authors.affiliation: Department of Digestive Surgery CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Department of Biostatistics, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Goere
authors.affiliation: Surgical Oncologic & Digestive Unit, AP-HP, Hôpital Lariboisière, Université Paris-Diderot (USPC), Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Pocard
authors.affiliation: Department of Digestive Surgery, AP-HP, Hôpital Louis Mourier, Université Paris-Diderot (USPC), Colombes, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.affiliation: Department of Digestive Surgery CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Passot
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Elias
authors.affiliation: Surgical Oncologic & Digestive Unit, AP-HP, Hôpital Lariboisière, Université Paris-Diderot (USPC), Paris, France.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Eveno
authors.affiliation: Department of Hepato-Gastroenterology, AP-HP, Hôpital Louis Mourier, Université Paris-Diderot (USPC), Colombes, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Sabaté
authors.affiliation: Department of Gastroenterology, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France.
authors.forename: Nelson
authors.initials: N
authors.lastname: Lourenco
authors.affiliation: Department of Medical Oncology, AP-HP, Hôpital Saint-Antoine, Université Pierre et Marie Curie (UMPC), Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: André
authors.affiliation: Department of Gastroenterology, AP-HP, Hopital Saint Louis, Université Paris-Diderot (USPC), Paris, France. jean-marc.gornet@aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003110:Colonic Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate