Platinum-based intraperitoneal chemotherapy improves disease-free survival after curative CRC resection
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Key Takeaway
Consider platinum-based intraperitoneal chemotherapy may improve DFS after CRC resection, but OS benefit remains unconfirmed.
This systematic review and meta-analysis examined platinum-based prophylactic intraperitoneal chemotherapy (PIC) administered during or after curative colorectal cancer resection in 1,264 adults, compared to surgery alone or standard systemic therapy. The analysis focused on overall survival, disease-free survival, and peritoneal recurrence outcomes.
For disease-free survival, PIC showed significant improvement with a hazard ratio of 0.57 (95% CI 0.42-0.78, p=0.0004). Overall survival trended toward benefit but was not statistically significant (HR 0.87, 95% CI 0.69-1.12, p=0.28). Peritoneal recurrence was reduced but showed substantial heterogeneity (RR 0.69, 95% CI 0.29-1.63, p=0.40, I²=85%).
Safety analysis found no significant increase in grade 3-4 adverse events (RR 1.26, 95% CI 0.97-1.64, p=0.08) or major complications. Key limitations include high heterogeneity in peritoneal recurrence results and the need for larger randomized controlled trials with longer follow-up to confirm potential survival benefits and determine optimal protocols. This evidence suggests platinum-based PIC may enhance disease-free survival without increasing adverse events, but clinical application should await more definitive trial data.
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View Original Abstract ↓
BACKGROUND: Peritoneal recurrence is a significant concern after curative resection of colorectal cancer (CRC), with systemic chemotherapy providing limited prevention. Prophylactic intraperitoneal chemotherapy (PIC) using platinum-based agents offers a potential strategy to reduce recurrence and improve survival.
OBJECTIVE: Our objective was to assess the effectiveness of platinum-based PIC in reducing peritoneal recurrence and enhancing survival outcomes when administered during or after curative CRC resection versus surgery alone or standard systemic therapy.
METHODS: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Databases were searched from January 2015 to September 2025 for randomized and comparative studies of adults receiving curative CRC resection with platinum-based PIC versus controls. Primary outcomes were overall survival (OS), disease-free survival (DFS), and peritoneal recurrence. Secondary outcomes were grade 3-4 adverse events and major complications. Random-effects meta-analyses in R used hazard ratios (HRs) for time-to-event outcomes and risk ratios (RRs) for binary outcomes; heterogeneity was assessed via I.
RESULTS: In total, 16 studies were included in the qualitative synthesis and seven (three randomized controlled trials, four cohorts; n=1264) in the meta-analysis. Platinum-based PIC improved DFS (HR 0.57; 95% confidence interval [CI] 0.42-0.78, p=0.0004, I=0%) and trended toward an OS benefit (HR 0.87; 95% CI 0.69-1.12, p=0.28, I=0%). Peritoneal recurrence was reduced but heterogeneous (RR 0.69; 95% CI 0.29-1.63, p=0.40, I=85%). No increases were observed in grade 3-4 events (RR 1.26; 95% CI 0.97-1.64, p=0.08, I=0%) or complications (RR 1.02; 95% CI 0.74-1.39, p=0.91, I=39%).
CONCLUSIONS: Platinum-based PIC appears to enhance DFS without increasing adverse events or complications. Larger randomized controlled trials with longer follow-up are needed to confirm potential survival benefits and determine optimal protocols.
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