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Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis

Wim Ceelen (UGent) , Yves Van Nieuwenhove (UGent) , Dirk Van de Putte (UGent) and Piet Pattyn (UGent)
(2014) ANNALS OF SURGICAL ONCOLOGY. 21(9). p.3023-3028
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Abstract
Background. In selected patients with colorectal peritoneal carcinomatosis (PC), cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) may improve survival. We aimed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population. Methods. Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin (200-460 mg/m(2)) or mitomycin C (35 mg/m(2)). Postoperative outcome and long-term survival were prospectively recorded. The impact of clinical variables on overall survival (OS) was assessed using univariate and Cox multivariate analysis. Results. Between October 2002 and May 2012, 166 patients were treated with CRS and HIPEC. Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients. Postoperative mortality and major morbidity were 2.4 and 35 %, respectively. Half of the patients received adjuvant chemotherapy. After a median follow-up of 18 months, OS was 27 months (95 % confidence interval 20.8-33.2). On univariate analysis, OS was associated with extent of disease (P < 0.001), neoadjuvant chemotherapy with bevacizumab (P = 0.021), completeness of cytoreduction (CC) (P < 0.001), and adjuvant chemotherapy (P = 0.04), but not with primary disease site, synchronous presentation, or chemoperfusion drug. In multivariate Cox regression, independent predictors of OS were CC (hazard ratio 0.29, P < 0.001) and neoadjuvant therapy containing bevacizumab (hazard ratio 0.31, P = 0.019). Conclusions. Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab. This regimen merits prospective study in patients with resectable PC of colorectal origin.
Keywords
LIVER METASTASES, PERITONEAL CARCINOMATOSIS, SYSTEMIC CHEMOTHERAPY, OVARIAN-CANCER, SURGERY, OXALIPLATIN, MANAGEMENT, MORBIDITY, MITOMYCIN, TOXICITY

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MLA
Ceelen, Wim, Yves Van Nieuwenhove, Dirk Van de Putte, et al. “Neoadjuvant Chemotherapy with Bevacizumab May Improve Outcome After Cytoreduction and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Colorectal Carcinomatosis.” ANNALS OF SURGICAL ONCOLOGY 21.9 (2014): 3023–3028. Print.
APA
Ceelen, Wim, Van Nieuwenhove, Y., Van de Putte, D., & Pattyn, P. (2014). Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis. ANNALS OF SURGICAL ONCOLOGY, 21(9), 3023–3028.
Chicago author-date
Ceelen, Wim, Yves Van Nieuwenhove, Dirk Van de Putte, and Piet Pattyn. 2014. “Neoadjuvant Chemotherapy with Bevacizumab May Improve Outcome After Cytoreduction and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Colorectal Carcinomatosis.” Annals of Surgical Oncology 21 (9): 3023–3028.
Chicago author-date (all authors)
Ceelen, Wim, Yves Van Nieuwenhove, Dirk Van de Putte, and Piet Pattyn. 2014. “Neoadjuvant Chemotherapy with Bevacizumab May Improve Outcome After Cytoreduction and Hyperthermic Intraperitoneal Chemoperfusion (HIPEC) for Colorectal Carcinomatosis.” Annals of Surgical Oncology 21 (9): 3023–3028.
Vancouver
1.
Ceelen W, Van Nieuwenhove Y, Van de Putte D, Pattyn P. Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis. ANNALS OF SURGICAL ONCOLOGY. 2014;21(9):3023–8.
IEEE
[1]
W. Ceelen, Y. Van Nieuwenhove, D. Van de Putte, and P. Pattyn, “Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis,” ANNALS OF SURGICAL ONCOLOGY, vol. 21, no. 9, pp. 3023–3028, 2014.
@article{5741698,
  abstract     = {Background. In selected patients with colorectal peritoneal carcinomatosis (PC), cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) may improve survival. We aimed to assess whether neoadjuvant chemotherapy with or without bevacizumab is indicated in this patient population. 
Methods. Colorectal PC patients were treated with CRS and HIPEC using oxaliplatin (200-460 mg/m(2)) or mitomycin C (35 mg/m(2)). Postoperative outcome and long-term survival were prospectively recorded. The impact of clinical variables on overall survival (OS) was assessed using univariate and Cox multivariate analysis. 
Results. Between October 2002 and May 2012, 166 patients were treated with CRS and HIPEC. Neoadjuvant chemotherapy alone was administered to 21 % and neoadjuvant chemotherapy with bevacizumab to 16 % of patients. Postoperative mortality and major morbidity were 2.4 and 35 %, respectively. Half of the patients received adjuvant chemotherapy. After a median follow-up of 18 months, OS was 27 months (95 % confidence interval 20.8-33.2). On univariate analysis, OS was associated with extent of disease (P < 0.001), neoadjuvant chemotherapy with bevacizumab (P = 0.021), completeness of cytoreduction (CC) (P < 0.001), and adjuvant chemotherapy (P = 0.04), but not with primary disease site, synchronous presentation, or chemoperfusion drug. In multivariate Cox regression, independent predictors of OS were CC (hazard ratio 0.29, P < 0.001) and neoadjuvant therapy containing bevacizumab (hazard ratio 0.31, P = 0.019). 
Conclusions. Long-term OS after CRS and HIPEC for colorectal cancer is associated with CC and neoadjuvant therapy containing bevacizumab. This regimen merits prospective study in patients with resectable PC of colorectal origin.},
  author       = {Ceelen, Wim and Van Nieuwenhove, Yves and Van de Putte, Dirk and Pattyn, Piet},
  issn         = {1068-9265},
  journal      = {ANNALS OF SURGICAL ONCOLOGY},
  keywords     = {LIVER METASTASES,PERITONEAL CARCINOMATOSIS,SYSTEMIC CHEMOTHERAPY,OVARIAN-CANCER,SURGERY,OXALIPLATIN,MANAGEMENT,MORBIDITY,MITOMYCIN,TOXICITY},
  language     = {eng},
  number       = {9},
  pages        = {3023--3028},
  title        = {Neoadjuvant chemotherapy with bevacizumab may improve outcome after cytoreduction and hyperthermic intraperitoneal chemoperfusion (HIPEC) for colorectal carcinomatosis},
  url          = {http://dx.doi.org/10.1245/s10434-014-3713-7},
  volume       = {21},
  year         = {2014},
}

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