NEW YORK (Reuters Health) - Patients with non-appendiceal invasive colorectal cancer who are treated with cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (IPHC) survived longer than untreated patients, according to the results of a retrospective study of 77 patients.
After 3 years, the median overall survival rate was 25%, and after 5 years, it was 17%, the investigators report in the February issue of the Annals of Surgical Oncology. Without treatment, the average survival for patients with peritoneal carcinomatosis is 3 to 6 months.
The findings indicate that this treatment can improve outcomes for select colorectal cancer patients who experience a spread of the cancer into the abdomen, especially if complete resection of all the cancer can be achieved, lead author Dr. Perry Shen of Wake Forest University, Winston-Salem, North Carolina, told Reuters Health.
Surgery plus IPHC has proven to be an effective treatment for colorectal cancer that spreads to the appendix, as well as a few other rare cancers, Dr. Shen said.
“In many cases you cannot remove the entire tumor,” Dr. Shen continued. “But if you remove as much of the bulky tumor as possible, we observed a median overall survival of 28 months.” Of the 77 patients, the surgeons were able to achieve a complete resection in 37 (48%), during procedures between 1991 and 2002.
Dr. Shen said animal studies indicate that IPHC penetrates surrounding tissue in a radius of about 5 millimeters, potentially eradicating cancer cells that have migrated away from the tumor site. Delivering IPHC after the resection is completed allows higher concentrations of the drug to go directly to the site of the tumor while minimizing systemic toxicity. If chemotherapy is delivered normally, it fails to achieve similar concentrations at the tumor site, Dr. Shen said.
Other experimental evidence indicates tumor tissue is more sensitive to heat than normal tissue. As a result, the tumor has less resistance to chemotherapy when the temperature of the drug is raised.
Nearly 75% of the patients had received chemotherapy prior to the surgery and IPHC treatment. The median age of the participants was 54 years old. Of the total procedures, 74 were conducted to resect a primary site in colon and 3 in the rectum. All the patients in the study had a histological diagnosis of adenocarcinoma.
Perioperative morbidity and mortality were 30% and 12%, respectively. About 19% of the patients experienced hematological toxicity.
Dr. Shen’s group notes that future research may include the use of molecular markers to determine which patients would derive the most benefit from surgery plus IPHC.
Source: Ann Surg Oncol 2004;11:178-186. [ Google search on this article ]
MeSH Headings:Behavioral Sciences: Colorectal Surgery: Combined Modality Therapy: Data Collection: Demography: Behavioral Disciplines and Activities: Drug Therapy: Environment and Public Health: Epidemiologic Methods: Health: Health Occupations: Health Services Administration: Information Science: Medicine: Investigative Techniques: Mortality: Population Characteristics: Preventive Medicine: Public Health: Quality of Health Care: Social Sciences: Specialties, Medical: Specialties, Surgical: Therapeutics: Vital Statistics: Epidemiologic Measurements: Survival Rate: Chemotherapy, Adjuvant: Health Care Quality, Access, and Evaluation: Health Care Evaluation Mechanisms: Analytical, Diagnostic and Therapeutic Techniques and Equipment: Anthropology, Education, Sociology and Social Phenomena: Biological Sciences: Health Care: Information Science: Psychiatry and PsychologyCopyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
