Table 4. Results of updated systematic review on adjuvant HIPEC in colorectal cancer patients at high risk of developing peritoneal metastases.
| author, year, design | inclusion criteria | n | HIPEC strategy + adjuvant systemic therapy | Overall/disease free survival | Peritoneal recurrence |
|---|---|---|---|---|---|
| Chouillard2009, single centre cohort[32] | colorectal cancer-T4,-pN2,-perforation,-positive peritoneal lavage,- peritumoral peritoneal nodules | 16 | Laparoscopic HIPEC, staged (median 5weeks, rang (0-8))MMC 80mg/m2, T=42-44°C t=35-45min | median FU 15.5 months2/16 died3/14 alive with metastasis | 0% (median FU 15.5 months, range 8-29) |
| Lygidakis, 2010, single centre cohort [34] | rectal cancerN+, neurovascular involvement | 87 | Laparoscopic HIPEC, three procedures (22 days post-op, 25 days postop, 2 years postop)ip 5FU, Ox, LV, Ir; T=43C°; t=60min | 1-year OS 100% | 5% (2 of 40 patients who completed 2 years of follow-up and underwent the third laparoscopic HIPEC) |
| (+4 cycles iv 5FU, Ox, LV, Ir) | |||||
| Tentes,2011, single centre cohort[33] | colorectal cancerT3/4 | 40 | Open, simultaneous with tumour resection,MMC 15mg/m2 T= 42.5-43°C t=90minor Ox 130mg/m2 T= 42.5-43°C t=60min(+6 cycles iv 5FU/LV in stage III/IV) | actuarial 3-year OS100% | 0% (median FU 17 months) |
| Sammartino, 2012, 2014matched comparison with control group[23], [24] | signet ring cell or mucinous colon cancerT3/4NxM0 | 25 | Closed, simultaneous with tumour resection,prophylactic target organ resection ( appendectomy, omentectomy, resection of the round hepatic ligament and bilateral ovariectomy) Ox 460mg/m2 T=43°C t=30min, + iv 5FU + LV(iv 5FU/Ox (n=13)) | median DFS: 36.8 monthsmedian OS: 59.5 months | 4% (FU >48 months) |
| 50 | (iv 5FU/Ox (n=23)) | median DFS: 21.9 monthsmedian OS: 52 months | 28% (FU >48 months) | ||
| p-value <0.05p-value < 0.04 | p-value <0.03 | ||||
| Baratti2016matched comparison with control group[22] | Colorectal cancer,- resected ovarian metastases,- minimal synchronous peritoneal disease (<1 cm in the omentum or close to the primary tumour),- T4a (n=8 vs. n=18)- T4b (n=9 vs. n=17) | 22 | Closed, simultaneous with tumour resection, prophylactic target organ resection (resection of the round hepatic ligament and lesser and greater omentectomy)Cisplatin 25mg/m2/L + MMC 3.3mg/m2/L T=42.5°C t=60min(iv 5FU/cap, FA, Ox (n=14), iv 5FU/cap, FA, Ox, Bev or Cet (n=4), 5FU/cap, FA, Ir, Bev or Cet (n=4)) | 5yOS: 81.3%5yPFS: 70.0% | 5y cumulative incidence9.3% (median FU 65.2 months) |
| 44 | (iv 5FU/cap, FA, Ox (n=29), iv 5FU/cap, FA, Ox, Bev or Cet (n=6), 5FU/cap, FA, Ir, Bev or Cet (n=6)) | 5yOS: 70.0%5yPFS: 18.3% | 5y cumulative incidence42.5% median FU 34.5 months | ||
| p-value = 0.046p-value = 0.008 | p-value <0.004 |
Bev: bevacizumab; Cap: capecitabin; Cet: Cetuximab; DFS: disease free survival; FA: folinic acid; FU: follow-up; HIPEC: hyperthermic intraperitoneal chemotherapy; ip: intra peritoneal; Ir: irinotecan; iv: intravenous; LV: leucovorin; MMC: mitomycine-C; OS: overall survival; Ox: oxaliplatin; PFS: progression free survival; T: temperature of intraperitoneal infusion; t: duration of infusion;. 5y: 5 year; 5FU: fluorouracil.