Dedicated MRI staging versus surgical staging of peritoneal metastases in colorectal cancer patients considered for CRS-HIPEC; the DISCO randomized multicenter trial

M. P. Engbersen*, C. J.V. Rijsemus, J. Nederend, A. G.J. Aalbers, I. H.J.T. de Hingh, V. Retel, D. M.J. Lambregts, E. J.R.J. Van der Hoeven, D. Boerma, M. J. Wiezer, M. De Vries, E. V.E. Madsen, A. R.M. Brandt-Kerkhof, S. Van Koeverden, P. R. De Reuver, R. G.H. Beets-Tan, N. F.M. Kok, M. J. Lahaye

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Selecting patients with peritoneal metastases from colorectal cancer (CRCPM) who might benefit from cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is challenging. Computed tomography generally underestimates the peritoneal tumor load. Diagnostic laparoscopy is often used to determine whether patients are amenable for surgery. Magnetic resonance imaging (MRI) has shown to be accurate in predicting completeness of CRS. The aim of this study is to determine whether MRI can effectively reduce the need for surgical staging. Methods: The study is designed as a multicenter randomized controlled trial (RCT) of colorectal cancer patients who are deemed eligible for CRS-HIPEC after conventional CT staging. Patients are randomly assigned to either MRI based staging (arm A) or to standard surgical staging with or without laparoscopy (arm B). In arm A, MRI assessment will determine whether patients are eligible for CRS-HIPEC. In borderline cases, an additional diagnostic laparoscopy is advised. The primary outcome is the number of unnecessary surgical procedures in both arms defined as: all surgeries in patients with definitely inoperable disease (PCI > 24) or explorative surgeries in patients with limited disease (PCI < 15). Secondary outcomes include correlations between surgical findings and MRI findings, cost-effectiveness, and quality of life (QOL) analysis. Conclusion: This randomized trial determines whether MRI can effectively replace surgical staging in patients with CRCPM considered for CRS-HIPEC. Trial registration: Registered in the clinical trials registry of U.S. National Library of Medicine under NCT04231175.

Original languageEnglish
Article number464
JournalBMC cancer
Volume21
Issue number1
Early online date26 Apr 2021
DOIs
Publication statusE-pub ahead of print/First online - 26 Apr 2021

Keywords

  • Colorectal peritoneal metastases
  • CRS-HIPEC
  • RCT
  • Surgical staging, MRI

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