title: Perioperative systemic chemotherapy for appendiceal mucinous carcinoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: BACKGROUND
  The role of systemic chemotherapy (SC) in conjunction with cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in appendiceal mucinous carcinoma peritonei (MCP) is unknown.
  
  
  METHODS
  A retrospective review (1999-2011) of MCP patients who had undergone CS/HIPEC with or without perioperative SC.
  
  
  RESULTS
  Twenty-two low-grade MCP patients treated with CS/HIPEC and SC were matched to patients who received CS/HIPEC alone. Median overall survival (OS) was 107 months for patients treated with perioperative SC compared to 72 without (P = 0.46). CS/HIPEC was performed on 109 patients with high-grade MCP: 70 were treated with perioperative SC, while 39 were not. Median OS (22.1 vs. 19.6 months, P = 0.74) and progression-free survival (PFS) (10.9 vs. 7.0 months, P = 0.47) were similar in patients treated with SC compared to CS/HIPEC alone. Progression while on pre-operative SC was seen in eight patients (17%), while four (8%) had a partial response. Treatment with post-operative SC was associated with longer PFS (13.6 months) compared to pre-operative SC (6.8 months, P < 0.01) and CS/HIPEC alone (7.0 months, P = 0.03).
  
  
  CONCLUSIONS
  Post-operative SC appears to improve PFS in patients with high-grade appendiceal MCP treated with CS/HIPEC. In contrast, there is no evidence to support the routine use of perioperative SC in low-grade disease.
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Aaron U
authors.initials: AU
authors.lastname: Blackham
authors.forename: Katrina
authors.initials: K
authors.lastname: Swett
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Joseph
authors.initials: J
authors.lastname: Sirintrapun
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Kim R
authors.initials: KR
authors.lastname: Geisinger
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Votanopoulos
authors.forename: John H
authors.initials: JH
authors.lastname: Stewart
authors.forename: Perry
authors.initials: P
authors.lastname: Shen
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001063:Appendiceal Neoplasms / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies
keywords: appendiceal epithelial neoplasm; disseminated peritoneal adenomucinosis; overall survival; peritoneal mucinous carcinomatosis