TY - JOUR
T1 - Incidence and treatment of recurrent disease after cytoreductive surgery and intraperitoneal chemotherapy for peritoneally metastasized colorectal cancer
T2 - A systematic review
AU - van Oudheusden, T.R.
AU - Nienhuijs, S.W.
AU - Luyer, M.D.
AU - Nieuwenhuijzen, G.A.
AU - Lemmens, V.E.
AU - Rutten, H.J.
AU - de Hingh, I.H.
PY - 2015/10
Y1 - 2015/10
N2 - INTRODUCTION: The optimal treatment for peritoneal carcinomatosis (PC) of colorectal origin is a combination of cytoreductive surgery and intraperitoneal chemotherapy (CRS + IPC). Although 5-year survival rates of up to 40% have been reported, recurrent disease remains common and is estimated to be a strong negative prognostic factor for survival. This systematic review elaborates on the incidence of recurrent disease and the possibilities to prevent and treat recurrence.METHODS: Two searches were performed. To identify the magnitude of recurrent the disease, a search was performed in Pubmed and EMBASE until September 2014. A second search was performed in Pubmed to identify treatment of recurrent disease with secondary CRS + IPC.RESULTS: The first search resulted in 139 and 94 articles in Pubmed and EMBASE respectively. Among those, 28 were included. Overall recurrence rates ranged from 22.5 to 82%. Local, systemic and combined local-systemic recurrence ranged from 6 to 42.5%, 10.4-43% and 5.8-21.5%. Median time to recurrence varied from 9 to 23 months, three-year disease free survival ranged from 14 to 41.5%. The second search resulted in 140 articles among which 17 met the inclusion criteria. A total of 190 patients underwent secondary CRS. Median survival after the second procedure ranged from 18 to 55.7 months. One, two and three-year survival ranged between 66 and 94, 44-50 and 0-66%.CONCLUSION: Recurrence is very common after cytoreductive surgery and intraperitoneal chemotherapy for PC of colorectal origin. Repeat cytoreductive surgery suggests a potential survival benefit for a highly selected group. Therefore, strategies to prevent recurrence are of the utmost importance.
AB - INTRODUCTION: The optimal treatment for peritoneal carcinomatosis (PC) of colorectal origin is a combination of cytoreductive surgery and intraperitoneal chemotherapy (CRS + IPC). Although 5-year survival rates of up to 40% have been reported, recurrent disease remains common and is estimated to be a strong negative prognostic factor for survival. This systematic review elaborates on the incidence of recurrent disease and the possibilities to prevent and treat recurrence.METHODS: Two searches were performed. To identify the magnitude of recurrent the disease, a search was performed in Pubmed and EMBASE until September 2014. A second search was performed in Pubmed to identify treatment of recurrent disease with secondary CRS + IPC.RESULTS: The first search resulted in 139 and 94 articles in Pubmed and EMBASE respectively. Among those, 28 were included. Overall recurrence rates ranged from 22.5 to 82%. Local, systemic and combined local-systemic recurrence ranged from 6 to 42.5%, 10.4-43% and 5.8-21.5%. Median time to recurrence varied from 9 to 23 months, three-year disease free survival ranged from 14 to 41.5%. The second search resulted in 140 articles among which 17 met the inclusion criteria. A total of 190 patients underwent secondary CRS. Median survival after the second procedure ranged from 18 to 55.7 months. One, two and three-year survival ranged between 66 and 94, 44-50 and 0-66%.CONCLUSION: Recurrence is very common after cytoreductive surgery and intraperitoneal chemotherapy for PC of colorectal origin. Repeat cytoreductive surgery suggests a potential survival benefit for a highly selected group. Therefore, strategies to prevent recurrence are of the utmost importance.
KW - Antineoplastic Agents/therapeutic use
KW - Carcinoma/secondary
KW - Chemotherapy, Adjuvant
KW - Colorectal Neoplasms/pathology
KW - Cytoreduction Surgical Procedures
KW - Disease-Free Survival
KW - Humans
KW - Hyperthermia, Induced
KW - Incidence
KW - Infusions, Parenteral
KW - Neoplasm Recurrence, Local/epidemiology
KW - Peritoneal Neoplasms/secondary
KW - Prognosis
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=84943813868&partnerID=8YFLogxK
U2 - 10.1016/j.ejso.2015.05.018
DO - 10.1016/j.ejso.2015.05.018
M3 - Review article
C2 - 26175345
SN - 0748-7983
VL - 41
SP - 1269
EP - 1277
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
M1 - 4078
ER -