Long-term survival after HIPEC with mitomycin C versus oxaliplatin in patients with colorectal peritoneal metastases
Menée à partir de données néerlandaises 2010-2023 portant sur 366 patients présentant des métastases péritonéales ayant pour origine un cancer colorectal et traités par chirurgie de cytoréduction (durée médiane de suivi : 58,7 mois), cette étude analyse la survie à long terme après deux types de chimiothérapie hyperthermique intrapéritonéale, l'une à base d'oxaliplatine et l'autre à base de mitomycine C
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.
European Journal of Surgical Oncology , résumé, 2026