Metastases from the colon and rectum
If left untreated, median survival is usually <6 month. With modern chemotherapy, median survival is approximately 2 years.
A French study compated CRS-HIPEC with systemic chemotherapy and palliative surgery with oxaliplatin and found a median survival of 23.9 months in the standard group and 62.7 months in the CRS-HIPEC group after complete cytoreductive surgery (CC-0). The equivalent 5-year survival is 13% and 51%. In the study, CRS-HIPEC achieved better results compared to modern chemotherapy (17). One should be aware that different centers set different limits for disease extent to accept patients for (which was low in the French study).
In a randomized study between peritonectomy with HIPEC compared with oncological treatment, the median survival after peritonectomy was about 2 years and with oncological treatment, about 1 year.
CRS-HIPEC has been found to be especially effective in patients with low tumor volume measured by PCI, with high or moderately differentiated tumors, and if a complete surgical cytoreduction was possible.
Significant factors for survival:
- tumor differentiation, PCI, and grade of cytoreduction (15)
- number of organ resections has not been found to implicate survival (16)
- pseudomyxoma peritonei originating from the appendix
Disseminated peritoneal adenomucinous (DPAM)
Around 85% 10-year survival after peritonectomy and intraperitoneal chemotherapy. The specific effect of HIPEC compared to other intraperitoneal chemotherapy is not clear. Also, early postoperative intraabdominal chemotherapy may be associated with good results.
Peritoneal mucinous carcinomatosis (PMCA) and peritoneal mucinous carcinomatosis, intermediary type (PMCA-I/D)
About 40% 10-year survival. It is assumed that recurrence in the peritoneum after tumor that is benign in appearance can have malignant transformation over time.
The prognosis is poor for the entire group, but there are subgroups which can be treated producing very good results. CRS-HIPEC has become the new treatment strategy. In a study from 8 institutions with together 405 patients given HIPEC (18), the median survival was 53 months with 47% calculated 5-year survival. Four prognostic factors for survival were found:
- epithelial subtype
- absence of nodal metastases
- achievement of CC-0/1 and completion of HIPEC