Safety and efficacy of palliative systemic chemotherapy combined with colorectal self-expandable metallic stents in advanced colorectal cancer: A multicenter study.
OBJECTIVE
Self-expandable metallic stent (SEMS) placement is an accepted palliative therapy for management of acute malignant bowel obstruction in advanced colorectal cancer. Nevertheless, data are lacking on the effects of systemic chemotherapy combined with colorectal SEMS. The aim of this study was to investigate the safety and efficacy of palliative chemotherapy for advanced colorectal cancer combined with colorectal SEMS placement.


METHODS
This multicentre retrospective study included all consecutive advanced colorectal cancer patients who received first-line palliative chemotherapy combined with endoscopic stenting for colorectal cancer with obstruction. We analyzed the number of cycles and the type of combination used. The primary endpoint was overall survival. Secondary endpoints included progression-free survival, response rate, grade 3-4 toxicity and the outcomes of SEMS for malignant colorectal obstruction.


RESULTS
A total of 38 patients were included. Among them, 25 patients received oxaliplatin and 5-fluorouracil combination chemotherapy. Objective response and stabilization occurred in 38 and 24% of patients, respectively. The median overall survival and progression-free survival from the start of chemotherapy were 18 and 5months, respectively. The objective response rate and overall disease control rate were 38 and 62%, respectively. Toxicity was generally acceptable. Major complications related to stenting included perforation (8%), stent migration (5%), and reobstruction secondary to tumor ingrowths (13%).


CONCLUSIONS
Chemotherapy combined with colonic stenting as a first-line treatment seems to be a valid option in advanced colorectal cancer patients with malignant colorectal obstruction.
François Rabelais University, Tours, France; Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France.
Nicolas
N
Cézé
Department of Hepatogastroenterology, Henri Mondor University Hospital, AP-HP, Créteil, France.
Antoine
A
Charachon
Department of Hepatogastroenterology, General Hospital of Meaux, France.
Christophe
C
Locher
Department of Hepatogastroenterology, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France.
Thomas
T
Aparicio
Department of Clinical Oncology, Institut Curie St Cloud and Versailles St-Quentin University, France.
Emmanuel
E
Mitry
Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France.
Jean-Pierre
JP
Barbieux
Department of Hepatogastroenterology and Digestive Oncology, Georges Pompidou European University Hospital, AP-HP, Paris, France.
Bruno
B
Landi
François Rabelais University, Tours, France; Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France.
Etienne
E
Dorval
François Rabelais University, Tours, France; Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France.
Driffa
D
Moussata
François Rabelais University, Tours, France; Department of Hepatogastroenterology and Digestive Oncology, University Hospital of Tours, Tours, France. Electronic address: thierry.lecomte@med.univ-tours.fr.
Thierry
T
Lecomte
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D012189:Retrospective Studies; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Chemotherapy; Colonic stent; Colorectal cancer; Malignant large bowel obstruction