2: Neoadjuvant Chemotherapy Prior to Cytoreductive Surgery and Heated Intraperitoneal Chemoperfusion for Patients with Metachronous Colorectal Peritoneal Metastases: Experience at a High Volume Center

Monday, February 19, 2024

11:10 AM - 11:20 AM AST

Location: Miramar I & II

Abstract Presenter(s)

Michael M. Wach, MD

Surgical Oncology Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Submitter(s)

Michael M. Wach, MD

Surgical Oncology Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Author(s)

Michael M. Wach, MD

Surgical Oncology Fellow
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Kathrine A. Kelly, DO

Fellow
UPMC
Pittsburgh, Pennsylvania, United States
TL

Thien Le, PA

Surgical Oncology PA
University of Pittsburgh Medical Center, United States
JD

Joshua Derby, n/a

Research
UPMC, United States
GN

Geoffrey Nunns, MD

Faculty
UPMC, United States
MH

Matthew Holtzmann, MD

Faculty
UPMC, United States
Amer H. Zureikat, MD

Professor and Chief
Division of Surgical Oncology, University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
David L. Bartlett, MD

Faculty
AHN
Pittsburgh, Pennsylvania, United States
Steven Ahrendt, MD

Professor
University of Colroado
Aurora, Colorado, United States
JP

James F. Pingpank, Jr., MD

Faculty
UPMC
Pittsburgh, PA, United States
Haroon A. Choudry, MD

Faculty
UPMC
Pittsburgh, Pennsylvania, United States
Melanie Ongchin, MD

Faculty
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Disclosure(s):

Michael M. Wach, MD: No financial relationships to disclose

Kathrine A. Kelly, DO: No financial relationships to disclose

Melanie Ongchin, MD: No financial relationships to disclose

Introduction: Neoadjuvant chemotherapy (NACT) prior to Cytoreductive Surgery and Heated Intraperitoneal Chemoperfusion (CRS/HIPEC) for patients with metachronous colorectal cancer peritoneal metastases (CRPM) carries theoretical advantages however thus far has not demonstrated survival benefit.

Methods:

We conducted a retrospective single institution study of patients with CRPM with no evidence of extraabdominal disease undergoing CRS/HIPEC with or without NACT from 2002 to 2022. NACT was administered with the intent of eventual resection and finished within 3 months prior to operation. Survival was measured from date of CRPM diagnosis.

Results: A total of 208 patients with metachronous CRPM were identified. 134 patients (64.4%) underwent NACT during the study period while 74 patients (35.5%) underwent upfront CRS/HIPEC. 23 of 74 patients (31.1%) undergoing upfront CRS/HIPEC eventually underwent postoperative adjuvant chemotherapy. The majority of patients in the cohort were white (92.3%) and male (51.9%) with a median age of 57yrs. Poorly differentiated histology was noted in 41pts (19.7%) with lymph node metastases noted in 118 pts(56.7%). 155 pts (74.5%) had undergone previous systemic chemotherapy in their disease course prior to development of CRPM. The mean PCI of the cohort was 12.4 and the majority of patients underwent complete cytoreduction (CC0:178, 85.6%). Patients who received NACT demonstrated no difference in PCI (12.8 vs 11.7, p=.25) or undergoing complete cytoreduction (82.8% vs 90.5% p=.13) versus those who underwent upfront CRS/HIPEC. Disease progression observed during NACT did not impact eventual survival after surgery (p=.74). Patients undergoing NACT+CRS/HIPEC did not show a significant difference in 30 day rates of major complications (10.4% vs 8.1%, p=.58) or mortality (2.3% vs 1.4%, p=.64) There was no significant difference in median RFS (17.8 vs 24.4 months, p=.25) or OS (35.3 vs 33.7 months, p=.47, Figure 1) between those undergoing NACT vs upfront CRS/HIPEC.

Conclusions: Utilizing NACT prior to CRS/HIPEC for patients with metachronous CRPM did not demonstrate a difference in PCI encountered at operation, ability to obtain complete cytoreduction, complication rate, or long term survival. Further studies are needed to better evaluate the optimal role and timing of systemic chemotherapy in this patient population.

Learning Objectives:

Upon completion, participants will be able to describe the relationship of PCI and CC scores related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.
Upon completion, participants will be able to describe complication rates related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.
Upon completion, participants will be able to describe survival related to neoadjuvant chemotherapy for CRPM treated with CRS/HIPEC.