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




Hyperthermic intraperitoneal chemotherapy with oxaliplatin as treatment for peritoneal carcinomatosis arising from the appendix and pseudomyxoma peritonei: a survival analysis - Download this document for free, or read online. Document in PDF available to download.

World Journal of Surgical Oncology

, 12:332

First Online: 07 November 2014Received: 03 March 2013Accepted: 20 October 2014

Abstract

BackgroundAppendiceal 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.

MethodsData 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-m at 43°C over 30 minutes. Ronnett’s histologic classification was used for tumor grading.

ResultsBetween 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.

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

KeywordsPeritoneal neoplasms Appendiceal neoplasms Hyperthermic intraperitoneal chemotherapy Oxaliplatin AbbreviationsCTCAECommon Terminology Criteria for Adverse Events

CRScomplete surgical cytoreduction

CCRcompleteness of cytoreduction

DFSdisease-free survival

DPAMdisseminated peritoneal adenomucinosis

EPICearly postoperative intraperitoneal chemotherapy

HIPEChyperthermic intraperitoneal chemotherapy

ICUintensive care unit

MMCmitomycin C

OSoverall survival

OXoxaliplatin

PICperioperative intraperitoneal chemotherapy

PCIPeritoneal Cancer Index

PCperitoneal carcinomatosis

PMCAperitoneal mucinous carcinomatosis

PMCA-Iperitoneal mucinous carcinomatosis with intermediate features

Electronic supplementary materialThe online version of this article doi:10.1186-1477-7819-12-332 contains supplementary material, which is available to authorized users.

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Author: Eric Marcotte - Pierre Dubé - Pierre Drolet - Andrew Mitchell - Suzanne Frenette - Guy Leblanc - Yves E Leclerc - Lucas 

Source: https://link.springer.com/



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