title: Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience.
abstract: BACKGROUND
  Appendiceal neoplasms include tumors ranging from benign-appearing cells with widespread mucin deposits to aggressive poorly differentiated signet ring cell adenocarcinomas. Traditionally, these tumors are treated with cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. For some patients, cytoreductive surgery is not an option, and minimal published data exist in the management and outcome of these patients. A retrospective analysis was conducted to determine the benefit of modern systemic chemotherapy in patients with disseminated appendiceal neoplasm who were not considered optimal candidates for cytoreductive surgery.
  
  
  METHODS
  A retrospective review was conducted using The University of Texas M. D. Anderson Cancer Center tumor registry between January 2000 and July 2005. Response was determined by radiographic response and/or overall clinical benefit.
  
  
  RESULTS
  Of 186 patients diagnosed with appendiceal neoplasm, 54 (29%) patients considered to be suboptimal surgical candidates received > or =2 cycles of systemic chemotherapy. Thirty (55.6%) patients had a disease control rate noted as a complete response, partial response, or stable disease. After a median follow-up of 24 months, the median progression-free survival (PFS) and overall survival were determined to be 7.6 months (95% confidence interval [CI], 4-11) and 56 months (95% CI, 36-not applicable), respectively.
  
  
  CONCLUSIONS
  Systemic chemotherapy has a role in appendiceal neoplasm patients who are suboptimal candidates for cytoreductive surgery. The intermediate PFS indicates the challenges that exist for appendiceal neoplasm patients in this setting. Prospective randomized trials including systemic chemotherapy are needed to provide further insight into this malignancy, for which no standard exists.
authors.affiliation: Division of Pharmacy, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-1402, USA.
authors.forename: Jamie F
authors.initials: JF
authors.lastname: Shapiro
authors.forename: Judy L
authors.initials: JL
authors.lastname: Chase
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lambert
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Overman
authors.forename: Aki
authors.initials: A
authors.lastname: Ohinata
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001063:Appendiceal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis