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Hyperthermic intraperitoneal chemotherapy with oxaliplatin as treatment for peritoneal carcinomatosis arising from the appendix and pseudomyxoma peritonei: a survival analysis.

Marcotte E, Dubé P, Drolet P, Mitchell A, Frenette S, Leblanc G, Leclerc YE, Sideris L - World J Surg Oncol (2014)

Bottom Line: In regards to the five-year disease-free survival for the HIPEC patients, histologic grade (disseminated peritoneal adenomucinosis 100%, peritoneal mucinous carcinomatosis with intermediate features 40%, peritoneal mucinous carcinomatosis 20%; p=0.0016) and completeness of cytoreduction (CCR-0 56%, CCR-1 24%; P=0.0172) were prognostic factors.This therapeutic approach seems both feasible and safe in selected patients.Recurrence is, however, frequent and represents a challenge.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, 5415 boulevard de l'Assomption, Montréal, Québec H1T 2 M4, Canada. lucas.sideris@umontreal.ca.

ABSTRACT

Background: Appendiceal peritoneal carcinomatosis (PC) is rare and its long-term prognosis is poor. The aim of this study was to evaluate the results of an aggressive treatment approach used in our institution for the last eight years.

Methods: Data from all patients with PC arising from the appendix were prospectively collected and analyzed. Treatment consisted of complete surgical cytoreduction (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (460 mg/m2) at 43°C over 30 minutes. Ronnett's histologic classification was used for tumor grading.

Results: Between February 2003 and April 2011, 78 patients underwent laparotomy with curative intent. The mean follow-up period was 33.7 months. A total of 58 patients received HIPEC, but 11 patients could not have CRS and received no HIPEC. Nine patients with a negative second-look surgery also received no HIPEC. The five-year overall survival for the entire cohort was 66.2%; 100% for the negative second-look patients, 77% for the HIPEC patients and 9% for the unresectable patients (P<0.0001). A total of 15 patients (25.9%) had isolated peritoneal recurrence, no patient had visceral recurrence only, and five patients (8.6%) had both. In regards to the five-year disease-free survival for the HIPEC patients, histologic grade (disseminated peritoneal adenomucinosis 100%, peritoneal mucinous carcinomatosis with intermediate features 40%, peritoneal mucinous carcinomatosis 20%; p=0.0016) and completeness of cytoreduction (CCR-0 56%, CCR-1 24%; P=0.0172) were prognostic factors. There was one postoperative mortality. The major complication rate for patients treated with HIPEC was 40%, including intra-abdominal abcess (17%), hemorrhage (12%) and anastomotic leak (10%). One patient in the HIPEC group experienced temporary grade II neuropathy and grade III thrombocytopenia.

Conclusions: This therapeutic approach seems both feasible and safe in selected patients. Recurrence is, however, frequent and represents a challenge.

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Related in: MedlinePlus

Overall survival at 60 months for patients who underwent complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) who were found to have unresectable disease and those who had a negative second-look surgery.
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Fig1: Overall survival at 60 months for patients who underwent complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) who were found to have unresectable disease and those who had a negative second-look surgery.

Mentions: The mean follow-up period was 33.7 months (median: 29.1; range: 2 to 100.8) for the entire series. The estimated five-year OS rate for the entire series was 66% (95% CI, 51 to 78). The estimated five-year OS was 100% for the negative second-look patients, 77% (95% CI, 57 to 88) for the HIPEC patients, and 9% (95% CI, 1 to 33) for the unresectable patients (P <0.0001) (Figure 1). In the HIPEC group, at the time of data analysis, 15 patients (25.9%) had isolated peritoneal recurrence, no patient had visceral recurrence only, and five patients (8.6%) had both. The estimated five-year DFS for the HIPEC group was 50% (95% CI, 30 to 66) and 100% for the negative second-look group (P =0.0478) (Figure 2).Figure 1


Hyperthermic intraperitoneal chemotherapy with oxaliplatin as treatment for peritoneal carcinomatosis arising from the appendix and pseudomyxoma peritonei: a survival analysis.

Marcotte E, Dubé P, Drolet P, Mitchell A, Frenette S, Leblanc G, Leclerc YE, Sideris L - World J Surg Oncol (2014)

Overall survival at 60 months for patients who underwent complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) who were found to have unresectable disease and those who had a negative second-look surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233099&req=5

Fig1: Overall survival at 60 months for patients who underwent complete surgical cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) who were found to have unresectable disease and those who had a negative second-look surgery.
Mentions: The mean follow-up period was 33.7 months (median: 29.1; range: 2 to 100.8) for the entire series. The estimated five-year OS rate for the entire series was 66% (95% CI, 51 to 78). The estimated five-year OS was 100% for the negative second-look patients, 77% (95% CI, 57 to 88) for the HIPEC patients, and 9% (95% CI, 1 to 33) for the unresectable patients (P <0.0001) (Figure 1). In the HIPEC group, at the time of data analysis, 15 patients (25.9%) had isolated peritoneal recurrence, no patient had visceral recurrence only, and five patients (8.6%) had both. The estimated five-year DFS for the HIPEC group was 50% (95% CI, 30 to 66) and 100% for the negative second-look group (P =0.0478) (Figure 2).Figure 1

Bottom Line: In regards to the five-year disease-free survival for the HIPEC patients, histologic grade (disseminated peritoneal adenomucinosis 100%, peritoneal mucinous carcinomatosis with intermediate features 40%, peritoneal mucinous carcinomatosis 20%; p=0.0016) and completeness of cytoreduction (CCR-0 56%, CCR-1 24%; P=0.0172) were prognostic factors.This therapeutic approach seems both feasible and safe in selected patients.Recurrence is, however, frequent and represents a challenge.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, 5415 boulevard de l'Assomption, Montréal, Québec H1T 2 M4, Canada. lucas.sideris@umontreal.ca.

ABSTRACT

Background: Appendiceal peritoneal carcinomatosis (PC) is rare and its long-term prognosis is poor. The aim of this study was to evaluate the results of an aggressive treatment approach used in our institution for the last eight years.

Methods: Data from all patients with PC arising from the appendix were prospectively collected and analyzed. Treatment consisted of complete surgical cytoreduction (CRS), followed by hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (460 mg/m2) at 43°C over 30 minutes. Ronnett's histologic classification was used for tumor grading.

Results: Between February 2003 and April 2011, 78 patients underwent laparotomy with curative intent. The mean follow-up period was 33.7 months. A total of 58 patients received HIPEC, but 11 patients could not have CRS and received no HIPEC. Nine patients with a negative second-look surgery also received no HIPEC. The five-year overall survival for the entire cohort was 66.2%; 100% for the negative second-look patients, 77% for the HIPEC patients and 9% for the unresectable patients (P<0.0001). A total of 15 patients (25.9%) had isolated peritoneal recurrence, no patient had visceral recurrence only, and five patients (8.6%) had both. In regards to the five-year disease-free survival for the HIPEC patients, histologic grade (disseminated peritoneal adenomucinosis 100%, peritoneal mucinous carcinomatosis with intermediate features 40%, peritoneal mucinous carcinomatosis 20%; p=0.0016) and completeness of cytoreduction (CCR-0 56%, CCR-1 24%; P=0.0172) were prognostic factors. There was one postoperative mortality. The major complication rate for patients treated with HIPEC was 40%, including intra-abdominal abcess (17%), hemorrhage (12%) and anastomotic leak (10%). One patient in the HIPEC group experienced temporary grade II neuropathy and grade III thrombocytopenia.

Conclusions: This therapeutic approach seems both feasible and safe in selected patients. Recurrence is, however, frequent and represents a challenge.

Show MeSH
Related in: MedlinePlus