SPİLİOTİS JOHN, FARMAKİS DİMİTRİOS, METAXAS THEODOROS, SPİLİOTİS NİKOLAOS JASONAS, SAROYAN HAYARPİ, GİANNİRİ MAİRİ, VAİKOS DİMİTRİOS, MARGARİ HARRİS, KARACHALİOS DİMİTRİOS
Eurasian Journal of Medicine and Oncology - 2022;6(4):323-329
Objectives: Peritoneal metastasis (PM) is a poor prognostic factor for all malignancies and remains difficult to treat with systemic chemotherapy because of poor peritoneal vascularization, resulting in limited drug delivery and penetration into tissues. Our study aims to investigate the efficacy and safety of different locoregional treatment protocols with hy perthermic intraperitoneal chemotherapy (HIPEC), Early Peritoneal Chemotherapy (EPIC), Pressurized Intraperitoneal Chemotherapy (PIPAC) in the management of advanced colorectal cancer with metachronous PM. Methods: A total of 42 patients were divided into three groups, as follows. Group A: After neoadjuvant systemic che motherapy, 15 patients received cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) and then adjuvant systemic chemotherapy. Group B: After neoadjuvant systemic chemotherapy, 12 patients received CRS + HIPEC + early postoperative intraperitoneal chemotherapy for 5 postoperative days and then adjuvant systemic chemotherapy. Group C: After neoadjuvant chemotherapy, 15 patients received CRS + HIPEC and then an adjuvant bedside HIPEC on the 10th postoperative day combined with postoperative adjuvant chemotherapy. Results: Patients in group A had a median overall survival (OS) of 33 months; however, log-rank tests showed that sur vival distributions of the three groups were not statistically significant different for both OS and disease-free survival. Conclusion: In conclusion, CRS plus HIPEC remains an alternative to locoregional treatment in well-selected patients with PM in combination with systemic neoadjuvant and adjuvant chemotherapy.
