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Long-term survival after HIPEC with mitomycin C versus oxaliplatin in patients with colorectal peritoneal metastases
Lizzel van der Snee1, Arend G J Aalbers2, Petur Snaebjornsson3
1Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, the Netherlands; GROW Research Institute for Oncology and Reproduction, Maastricht UMC+, Universiteitssingel 40, Maastricht, 6229 ER, the Netherlands.
Background:
Cytoreductive surgery (CRS) and oxaliplatin-based hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial in patients with colorectal peritoneal metastases, particularly in those who have received prior systemic oxaliplatin. In the Netherlands, upfront CRS-HIPEC remains the preferred treatment. The aim was to compare the survival of patients with colorectal peritoneal metastases treated with CRS and mitomycin C versus oxaliplatin-based HIPEC.
Methods:
This was a retrospective, single-center cohort study of consecutive patients with colorectal peritoneal metastases who underwent macroscopic complete CRS-HIPEC between 2010 and 2023. Main outcomes were differences in disease-free, peritoneal disease-free, distant disease-free, and overall survival.
Results:
Of 366 patients included, 153 and 213 underwent mitomycin C-based and oxaliplatin-based HIPEC, respectively. Most patients (68.6%) underwent upfront CRS-HIPEC. Median follow-up was 58.7 months (range, 24.8 - 175.1) and median overall survival was 43.3 months (95% CI, 36.5 - 49.9). In multivariable analyses, oxaliplatin-based HIPEC was associated with worse peritoneal disease-free survival compared to mitomycin C-based HIPEC (median 11.3 vs. 14.9 months; HR 1.44, 95% CI, 1.09 - 1.90; P = .010). No difference was observed in disease-free, distant disease-free, and overall survival. Among patients treated with oxaliplatin-based HIPEC, prior systemic oxaliplatin exposure was associated with worse peritoneal disease-free survival (median 8.7 vs. 13.1 months; HR 1.59, 95% CI, 1.10 - 2.31; P = .014) and overall survival (median 35.7 vs. 50.6 months; HR 1.55, 95% CI, 1.07 - 2.23; P = .020) compared to no prior oxaliplatin exposure.
Conclusions:
Oxaliplatin-based HIPEC was associated with a higher risk of peritoneal recurrence, particularly in patients previously treated with systemic oxaliplatin. Mitomycin C-based HIPEC is a better choice in this subgroup.
