Surgery with HIPEC Increases Long Term Survival for Peritoneal Carcinomatosis

Over half of patients whose colorectal cancer had spread to their abdominal cavity were alive five years after treatment in a French center with surgery and heated chemo.  This was substantially better than those who only received modern chemotherapies without surgery.

Peritoneal carcinomatosis is diagnosed when cancer spreads into the abdominal cavity and tumors develop on the surface of abdominal organs.  In the past peritoneal carcinomatosis has been a difficult condition to treat with very poor results from chemotherapy.  However, surgery to remove all signs of tumor followed by washing the open abdomen after surgery with heated chemotherapy is achieving some remarkable results.

Five years after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) in a French cancer center, 51 percent of patients were alive.  Research surgeons compared these results to a comparable group of patients treated with modern systemic chemotherapy where cytoreductive techniques were not available.

After systemic chemotherapy with modern drugs, 13 percent of patients were alive five years later.  Median survival time was 24 months, compared to 63 months for patients treated with cytoreductive surgery and HIPEC.  All patients in the study had tumors that were isolated in their abdomens, and their cancer had not spread beyond the abdomen.

About 11 percent of people with colorectal cancer will develop peritoneal carcinomatosis.  Traditionally, it has been extremely difficult to treat.  Older chemotherapies, that did not include oxaliplatin or irinotecan, resulted in median survival times from 5 to 12 months.  In this study, using more modern chemotherapy that included irinotecan and oxaliplatin, median survival for standard therapy group reached 24 months.

However, results after surgery and HIPEC were much better with a median survival of more than 5 years (63 months.)

It is important to understand that patients in the study were carefully selected to have cytoreductive surgery and the patients in the standard group were similar in having cancer that would have been treated with the cytoreductive technique had it been available.  All had tumors that surgeons believed could be completely removed, and none had cancer that had spread beyond their abdominal cavity.

Dominique Elias from the Gustave Roussy Institute in Villejuif, France where the cytoreductive surgery and HIPEC was performed concluded,

Patients with isolated, resectable peritoneal carcinomatosis achieve a median survival of 24 months with modern chemotherapies, but only surgical cytoreduction plus HIPEC is able to prolong median survival to roughly 63 months, with a 5-year survival rate of 51%.

SOURCE: Elias et al., Journal of Clinical Oncology, published ahead of print, December 22, 2008.