Critical analysis of treatment failure after complete cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal dissemination from appendiceal mucinous neoplasms.
BACKGROUND
Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been suggested as a treatment strategy for peritoneal carcinomatosis. The objective of this data analysis was to study treatment failure after complete cytoreduction for peritoneal dissemination from appendiceal mucinous neoplasms.


METHODS
Before June 2006, a total of 402 patients with peritoneal dissemination from appendiceal mucinous neoplasms underwent complete cytoreduction and PIC at the Washington Cancer Institute. Patient characteristics, pathologic features, and treatment-related data were obtained from a prospective database. Survival analyses were performed by the Kaplan-Meier method and the Cox regression model.


RESULTS
After a median follow-up of 66 months, the 5- and 10-year progression-free survival rates for these 402 patients were 70% and 67%, respectively. Disease progression was the only independent risk factor for a reduced overall survival. One hundred eleven patients (28%) developed progressive disease. Of these, 98 patients underwent second-time and 26 patients third-time CRS and PIC. Complete cytoreduction after repeat surgery was the only independent prognostic factor for improved survival. The most common sites of treatment failure were on the small bowel and in the pelvis.


CONCLUSIONS
The present study reported the patterns of treatment failure after complete cytoreduction and demonstrated that a disease-free state is important for long-term survival in peritoneal dissemination from appendiceal mucinous neoplasms. Repeat complete cytoreduction should be pursued when possible and is associated with improved overall survival in patients with recurrent disease.
Yan
Tristan D
TD
Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, 106 Irving Street NW, Suite 3900N, Washington, DC 20010, USA.
Bijelic
Lana
L
Sugarbaker
Paul H
PH
D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D016685:Mitomycin; D005472:Fluorouracil