Background: The impact of using adjuvant chemotherapy following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with appendiceal adenocarcinoma is not known. The aim of this study was to assess the impact of adjuvant chemotherapy following complete cytoreduction in patients with appendiceal adenocarcinoma.
Methods: Retrospective medical record review of all patients with appendiceal adenocarcinoma treated at our institution between 2006 and 2015. Kaplan-Meier plots were used to summarize overall survival (OS) and relapse-free survival over time, and log-rank tests and Cox proportional hazards models were used to test for differences in survival between groups.
Results: A total of 103 patients with appendiceal adenocarcinoma received care at our institution during the study period. Complete cytoreduction (cytoreductive score 0-1) was achieved in 68 patients (66%). Of these 68 patients, 26 received adjuvant chemotherapy. The most common regimens were capecitabine (n = 11), capecitabine plus oxaliplatin (n = 7), and 5-FU plus oxaliplatin (n = 6). Tumor histopathology and grade, and the ability to achieve complete cytoreduction were significant predictors of overall survival. The median OS for non-low-grade and well-differentiated tumor patients who received adjuvant chemotherapy following complete cytoreduction was 9.03 years, compared to 2.88 years for patients who did not receive adjuvant chemotherapy (P = .02). Among low-grade and well-differentiated tumor patients who underwent complete cytoreduction, there was no statistically significant difference in OS between those who received adjuvant chemotherapy and those who did not.
Conclusion: Adjuvant chemotherapy seems to have benefit in appendiceal cancer patients with non-low-grade or well-differentiated tumor type but not in low-grade or well-differentiated tumors.
Keywords: adjuvant chemotherapy; appendiceal cancer; impact of chemotherapy; overall survival; progression-free survival.
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Hyperthermic intraperitoneal chemotherapy + early postoperative intraperitoneal chemotherapy versus hyperthermic intraperitoneal chemotherapy alone: assessment of survival outcomes for colorectal and high-grade appendiceal peritoneal carcinomatosis.Am J Surg. 2015 Sep;210(3):424-30. doi: 10.1016/j.amjsurg.2015.03.008. Epub 2015 May 12. Am J Surg. 2015. PMID: 26051744
Predictors of progression in high-grade appendiceal or colorectal peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.Ann Surg Oncol. 2015 May;22(5):1716-21. doi: 10.1245/s10434-014-3985-y. Epub 2014 Aug 22. Ann Surg Oncol. 2015. PMID: 25145504 Clinical Trial.
Adverse Events Postoperatively Had No Impact on Long-Term Survival of Patients Treated with Cytoreductive Surgery with Heated Intraperitoneal Chemotherapy for Appendiceal Cancer with Peritoneal Metastases.Ann Surg Oncol. 2016 Dec;23(13):4231-4237. doi: 10.1245/s10434-016-5355-4. Epub 2016 Jun 23. Ann Surg Oncol. 2016. PMID: 27338748
Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer.Colorectal Dis. 2018 Aug;20(8):704-710. doi: 10.1111/codi.14057. Colorectal Dis. 2018. PMID: 29502336
Peritoneal dissemination from high-grade appendiceal cancer treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).J Gastrointest Oncol. 2016 Feb;7(1):3-9. doi: 10.3978/j.issn.2078-6891.2015.101. J Gastrointest Oncol. 2016. PMID: 26941979 Free PMC article.
- Sugarbaker PH. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol. 2006;7:69-76.
- Asare EA, Compton CC, Hanna NN, et al. The impact of stage, grade, and mucinous histology on the efficacy of systemic chemotherapy in adenocarcinomas of the appendix: analysis of the National Cancer Data Base. Cancer. 2016;122:213-221.
- Shapiro JF, Chase JL, Wolff RA, et al. Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin: a single-institution experience. Cancer. 2010;116:316-322.
- Smith JW, Kemeny N, Caldwell C, Banner P, Sigurdson E, Huvos A. Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience. Cancer. 1992;70:396-401.
- Gough DBDJ, Schutt AJ, Gonchoroff N, et al. Long-term patient survival with an aggressive regional approach. Ann Surg. 1994;219:112-119.