title: Long-term survival after aggressive treatment of relapsed serosal or distant pseudomyxoma peritonei.
abstract: BACKGROUND
  Complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have dramatically changed the prognosis of patients with pseudomyxoma peritonei (PMP). However, recurrences can still occur and no consensus has been reached regarding their optimal treatments. This study aimed to analyze the patterns of recurrence after CCRS plus HIPEC for PMP and potential subsequent treatments of these lesions.
  
  
  METHODS
  Between 1992 and 2014, patients who had relapsed after treatment of PMP were selected from a prospective database of 251 patients who had undergone CCRS plus HIPEC with a curative intent.
  
  
  RESULTS
  After a median follow-up of 85 months, 66 patients (26%) had relapsed with a median free interval of 25 months. The first recurrence was mostly located in the peritoneum, isolated in 50 patients (76%) and associated with extraperitoneal disease in 6 patients. Curatively intended treatment of the relapse, combining surgery and chemotherapy was achievable in 76% of the patients, leading to a 5-year overall survival (OS) rate of 83% from the date of treatment of the first recurrence. In contrast, the 5-year OS rate was only 27% (p < 0.001) for patients treated with non-curative therapy. An isolated peritoneal recurrence was predictive of greater amenability to curative therapy and a better prognosis.
  
  
  CONCLUSIONS
  After CCRS plus HIPEC, serosal recurrences were more common than their distant counterparts. Distant relapses' emergence has raised the question of their optimal treatments. Very long-term survival can be obtained after further treatment of recurrent PMP for patients with limited disease and good general status.
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Delhorme
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France. Electronic address: charles.HONORE@gustaveroussy.fr.
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Benhaim
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.affiliation: Department of Pathology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Dartigues
authors.affiliation: Department of Radiology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Dromain
authors.affiliation: Department of Medical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Ducreux
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard vaillant, 94805, Villejuif Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Goéré
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: HIPEC; Pseudomyxoma peritonei; Recurrence; Surgery; Treatment