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Patterns and Timing of Recurrence following CRS and HIPEC in Colorectal Cancer Peritoneal Metastasis

  • Sarah Hassan
    Correspondence
    Corresponding author. Flat 4, 34 Eldon Terrace, Reading, RG1 4DX, United Kingdom.
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom
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  • Lee Malcomson
    Affiliations
    Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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  • Yen Jia Soh
    Affiliations
    Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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  • Malcom S. Wilson
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom
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  • Hamish Clouston
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom
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  • Sarah T. O'Dwyer
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom

    Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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  • Rohit Kochhar
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom
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  • Omer Aziz
    Affiliations
    The Christie Peritoneal and Oncology Centre, Manchester, M20 4 BX, United Kingdom

    Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Published:August 03, 2022DOI:https://doi.org/10.1016/j.ejso.2022.07.019

      Abstract

      Introduction

      Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) is an established treatment of Colorectal Peritoneal Metastases (CRPM). This study aims to determine the timing and patterns of recurrent disease on imaging following complete CRS/HIPEC.

      Methods

      Retrospective analysis of a national peritoneal tumour service database identified CRPM patients with complete CRS/HIPEC(CC0) from 2005 to-2018. Patients with<2 years follow-up or and those where post-operative histology from the CRS/HIPEC procedure did not confirm CRPM from their original colorectal cancer were excluded. Time to recurrence was measured from surgery to first radiologically illustrated recurrence. CT was the primary modality used, supplemented by PET-CT or MRI if required. Outcomes of interest were survival data (including overall survival (OS), disease-free survival (DFS) and peritoneal-recurrence free survival (PRFS)), timing and patterns of recurrent disease.

      Results

      146 of the 176 patients identified were eligible for inclusion. Median OS for all study patients was 45.2 months (95% CI 38–53 months), median DFS was 11.7 months (95% CI 9–14 months), and median PRFS was 25.2 months (95% CI 14.7–30 months). Recurrent disease was seen in 112 cases (77%), radiologically classified as intraperitoneal in 50 patients (44%), single site systemic in 21 patients (19%) and multi-site in 41 patients (37%). CT detection rate for disease recurrence was 88%. Subgroup analyses showed that PCI ≥12, positive nodal primary disease and synchronous peritoneal disease were associated with worse outcomes.

      Conclusion

      Patients selected for CRS/HIPEC for CRPM have an OS > 45 months, with the majority recurring systemically within a year. Peritoneal recurrence is a later event after several years. Surveillance programs in this group should be most intensive in the first 2 years after surgery, using CT with oral and intravenous contrast.

      Keywords

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      References

        • Gelli M.
        • Huguenin JFL.
        • de Baere T.
        • Benhaim L.
        • Marianai A.
        • Boige V.
        • et al.
        Peritoneal and extraperitoneal relapse after previous curative treatment of peritoneal metastases from colorectal cancer: what survival can we expect?.
        Eur J Cancer. 2018; 100: 94-103
        • Lurvink R.J.
        • Bakkers C.
        • Rijken A.
        • van Erning FN
        • Nienhuijs SW
        • Burger JW
        • et al.
        Increase in the incidence of synchronous and metachronous peritoneal metastases in patients with colorectal cancer: A nationwide study.
        EJSO. May 2021; 4: 1026-1033
        • Franko J
        • Shi Q
        • Meyers JP
        • Maughan TS
        • Adams RA
        • Seymour MT
        • et al.
        Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancer of the Digestive System (ARCAD) database.
        Lancet Oncol. 2016 Dec; 17: 1709-1719
        • Sanchez-Hidalgo J.M.
        • Rodriguez-Ortiz L
        • Arjona-Sanchez A
        • Rufian-Pena S
        • Casado-Adam A
        • Cosano-Alvarez A
        • et al.
        Colorectal peritoneal metastases: Optimal management review.
        World J Gastroenterol. 2019 Jul 2021; 25: 3484-3502
        • Lambert L.
        • Wiseman J.
        Palliative management of peritoneal metastases.
        Ann Surg Oncol. 2018 Aug; 25: 2165-2171
        • Cutsem E.V.
        • Cervantes A.
        • Adam R.
        • Sobrero A.
        • Van Krieken J.H.
        • Aderka D.
        ESMO Consensus guidelines for the management of patients with metastatic colorectal cancer.
        Ann Oncol. 2016; 27: 1386-1422https://doi.org/10.1093/annonc/mdw235
        • Colorectal Cancer (NG151)
        NICE guideline 29 january 2020.
        (40)
        • Elias D
        • Roca L
        • Goere D
        • Ghouti L
        • Pocard M
        • et al.
        Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy versus cytoreductive surgery alone for colorectal peritoneal metastases (PRODIGE 7): a multicentre, randomised, open-label, phase 3 trial.
        Lancet Oncol. 2021 Feb; 22: 256-266
        • Verwaal V.J.
        • Bruin S.
        • Boot H.
        • van Slooten G.
        • van Tinteran
        8 year follow up of randomised trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal metastases of colorectal cancer.
        Ann Surg Oncol. 2008; 15: 2426-2432
        • EliasD
        • Lefevre J.H.
        • Chevalier J.
        • Brouquet A.
        • Marchal F.
        • Classe J.M.
        • et al.
        Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin.
        J Clin Oncol. 2009; 27: 681-685
        • Larentzakis A.
        • O’Dwyer ST
        • Becker J
        • Shuweihdi F
        • Aziz O
        • Selvasekar CR
        • et al.
        Referral pathways and outcome of patients with colorectal peritoneal metastasis (CRPM).
        Eur J Surg Oncol. 2019 Dec; 45: 2310-2315
        • Turner K.
        • Morris M.C.
        • Sohal D.
        • Sussman JJ
        • Wilson GC
        • Ahmad SA
        • et al.
        Cytoreductive Surgery and Hyperthermic intraperitoneal chemotherapy for Colorectal Periotneal Metastases: A summary of Key Clinical Trials.
        J Clin Med. 2002; 11: 3406
        • Sugarbaker P.H.
        • Jablonski K.A.
        Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy.
        Ann Surg. 1995; 221: 124-132
        • Klacer C.E.
        • Groenen H.
        • Morton D.G.
        • Laurberg S.
        • Bemelman W.A.
        • Tanis P.J.
        • et al.
        Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines.
        Colorectal Dis. 2017; 19: 224-236
        • Esquivel J.
        • Sticca R.
        • Sugarbaker P.
        • Levine E.
        • Yan T.D.
        • Alexander R.
        • et al.
        Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colorectal origin: a consensus statement. Society of Surgical Oncology.
        Ann Surg Oncol. 2007; 14: 128-133
        • Breuer E.
        • Hebeisen M.
        • Schneider M.A.
        • Roth L.
        • Chantal P.
        • Frischer-Ordu K
        • et al.
        Site of recurrence and survival after surgery for colorectal peritoneal mestastasis.
        J Natl Cancer Inst. 2021 Jan; 113: 1027-1035https://doi.org/10.1093/jnci/djab001
        • Portilla A.G.
        • Sugarbaker P.H.
        • Chang D.
        Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features.
        World J Surg. 1999; 23: 23-29
        • Laks S.
        • Schtechman G.
        • Adileh M.
        • Ben-Yaacov A
        • Purim O
        • Ivanov V
        • et al.
        Repeat cytoreductive surgery and intraperitoneal chemotherapy for colorectal cancer peritoneal recurrences is safe and efficacious.
        Ann Surg Oncol. February 2021; 28https://doi.org/10.1245/s10434-021-09684-7
        • Aziz O.
        • Jaradat I.
        • Chakrabarty B.
        • Selvasekar C.R.
        • Fulford P.E.
        • Saunders M.P.
        • et al.
        Predicting survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendix adenocarcinoma.
        Dis Colon Rectum. 2018; 61: 795-802
        • Faron M.
        • Macovei R.
        • Goere D.
        • Honore C
        • Benhaim L
        • Elias D
        • et al.
        Linear relationship of peritoneal cancer index and survival in patients with peritoneal metastases from colorectal cancer.
        Ann Surg Oncol. 2016; 23: 114-119
        • Hentzen J.E.K.R.
        • Rovers K.P.
        • Kuipers H.
        • van der Plas WY
        • Been LB
        • Hoogwater FJH
        • et al.
        Impact of synchronous versus metachronous onset of colorectal peritoneal metastases on survival outcomes after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC): a multicenter, retrospective, observational study.
        Ann Surg Oncol. 2019 Jul; 26: 2210-2221
        • Bakkers C.
        • Lurvink R.J.
        • Rijken A.
        • Nienhuijs SW
        • Kok NF
        • Creemers GJ
        • et al.
        Treatment strategies and prognosis of patients with synchronous or metachronous colorectal peritoneal metastases: a population-based study.
        Ann Surg Oncol. 2021 Jun; 28: 9073-9083
        • Feferman Y.
        • Solomon D.
        • Bhagwandin S.
        • Kim J.
        • Aycart S.N.
        • Feingold D.
        • et al.
        Sites of recurrence after complete cytoreduction and hyperthermic intraperitoneal chemotherapy for patients with peritoneal carcinomatosis from colorectal and appendiceal adenocarcinoma: a tertiary center experience.
        Ann Surg Oncol. 2019; 26: 482-489
        • Braam
        • van Oudhuesden TR
        • de Hingh IH
        • Nienhuijs SW
        • Boerma D
        • Wiezer MJ
        • et al.
        Patterns of recurrence following complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer.
        J Surg Oncol. 2014; 109: 841-847
        • Rover K.P.
        • Bakkers C.
        • Simkens G.
        • Burger J.
        • Nienhujis SW
        • Creemers GJM
        Perioperative systemic therapy and cytoreductive surgery with HIPEC versus upfront cytoreductive surgery with HIPEC alone for isolated resectable colroectal peritoneal metastases: protocol of a multicentre, open-label, parallel-group, phase II-III, randomised superiority study (CAIRO6).
        BMC Cancer. 2019; 19: 390
      1. Gaillard, F., Niknejad, M. Peritoneal metastases. Reference article, Radiopaedia.org. https://doi.org/10.53347/rID-1899.

        • Torkzad M.R.
        • Casta N.
        • Bergman A.
        Comparison between MRI and CT in prediction of peritoneal carcinomatosis index (PCI) in patients undergoing cytoreductive surgery in relation to the experience of the radiologist.
        JSO. 2015; 11: 746-751
        • Healy J.C.
        Detection of peritoneal metastases.
        Cancer Imag. 2001 May 2015; 1: 4-12
        • Mahmoud B.E
        • Abdelzaher AA
        • Mohamed AA
        • Metwally LIA
        The role of diffusion-weighted MR imaging in assessment of peritoneal lesions: radiologic-pathologic correlation.
        Egypt J Radiol Nucl Med. 2020; 51: 149
        • Engbersen M.P.
        • Rijsemus C.J.V.
        • Nederend J.
        • Aalbers AGJ
        • de Hingh IHJT
        • Retel V
        • et al.
        Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomised multicentre trial.
        BMC Cancer. 2021; 21: 464