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Modern systemic chemotherapy in surgically unresectable neoplasms of appendiceal origin
Author(s) -
Shapiro Jamie F.,
Chase Judy L.,
Wolff Robert A.,
Lambert Laura A.,
Mansfield Paul F.,
Overman Michael J.,
Ohinata Aki,
Liu Jun,
Wang Xuemei,
Eng Cathy
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24715
Subject(s) - medicine , chemotherapy , hyperthermic intraperitoneal chemotherapy , malignancy , signet ring cell , cancer , surgery , retrospective cohort study , adenocarcinoma , cytoreductive surgery , ovarian cancer
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 ≥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. Cancer 2010. © 2010 American Cancer Society.