Neoadjuvant FOLFOX chemotherapy in 34 consecutive patients with mucinous peritoneal carcinomatosis of appendiceal origin

Sugarbaker, Paul H.; Bijelić, Lana; Chang, David; Yoo, Dal

doi:10.1002/jso.21679

Cited by 91 publications

(64 citation statements)

References 18 publications

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“…• Close the abdomen and consider neoadjuvant systemic chemotherapy until the best tumour response has been achieved and then try again 56 (loc b). This approach is encouraged in the case of grade 1 or 2 classical adenocarcinoma, when a cc0 resection seems hard to achieve as demonstrated by the assessment or when a very-highrisk resection seems the only way to achieve cc0.…”

Section: Intraoperative Assessmentmentioning

confidence: 99%

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

et al. 2015

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To meet the needs of patients, Canadian surgical and medical oncology leaders in the treatment of peritoneal surface malignancies (psms), together with patient representatives, formed the Canadian HIPEC Collaborative Group (chicg). The group is dedicated to standardizing and improving the treatment of psm in Canada so that access to treatment and, ultimately, the prognosis of Canadian patients with psm are improved.Patients with resectable psm arising from colorectal or appendiceal neoplasms should be reviewed by a multidisciplinary team including surgeons and medical oncologists with experience in treating patients with psm. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy should be offered to appropriately selected patients and performed at experienced centres.The aim of this publication is to present guidelines that we recommend be applied across the country for the treatment of psm.

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Section: Intraoperative Assessmentmentioning

confidence: 99%

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

et al. 2015

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“…Although its effectiveness is not well established, systemic chemotherapy is more likely to be incorporated into a multimodal treatment strategy for tumors that are judged to be clinically aggressive. 15,22,23 In an attempt to codify the diagnostic terminology of appendiceal mucinous neoplasms, both the 4th edition of the World Health Organization (WHO) Classification of Tumors of the Digestive System and the 7th edition of the American Joint Committee on Cancer (AJCC) Staging Manual now differentiate low-grade mucinous neoplasms from high-grade, but they differ in their terminology and grading schemes. 24,25 The WHO identifies morphologic characteristics (architecture, cytology, presence of signet ring cells and mitotic activity) that can be used to classify low-and high-grade tumors.…”

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confidence: 99%

Clinicopathologic and molecular analysis of disseminated appendiceal mucinous neoplasms: identification of factors predicting survival and proposed criteria for a three-tiered assessment of tumor grade

et al. 2014

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Previous studies have demonstrated that the prognosis of disseminated mucinous appendiceal neoplasms is highly dependent upon tumor grade. Reflecting this, the 7th edition of the American Joint Committee on Cancer (AJCC) staging system now incorporates a three-tier grading system for prognostic staging of mucinous appendiceal tumors. However, the grading criteria are not well described. In order to address this issue, we evaluated clinicopathologic and molecular features of 219 cases from 151 patients with widely disseminated appendiceal mucinous neoplasia treated at our institution between 2004 and 2012. We identified histologic features that were associated with worse overall survival on univariate analysis: destructive invasion, high cytologic grade, high tumor cellularity, angiolymphatic invasion, perineural invasion, and signet ring cell component (all with Po0.0001). We used these morphologic characteristics to classify neoplasms into three grades: AJCC grade G1 lacked all adverse histologic features; AJCC grade G2 had at least one adverse histologic feature (except a signet ring cell component); and AJCC grade G3 were defined by the presence of a signet ring cell component. Patients with AJCC grade G2 and grade G3 adenocarcinomas had a significantly worse prognosis compared with AJCC grade G1 (Po0.0001 for each). A trend toward worse overall survival was identified for patients with AJCC grade G3 adenocarcinomas compared with AJCC grade G2 adenocarcinomas (P ¼ 0.07). Our multivariate analysis found that this three-tier grading system was a significant predictor of outcome (P ¼ 0.008), independent of other prognostic variables. After controlling for other prognostic variables, AJCC grade G2 was associated with a 2.7-fold increased risk of death (95% confidence interval (CI), 1.2-6.2) and AJCC grade G3 was associated with a 5.1-fold increased risk of death (95% CI, 1.7-14) relative to grade G1 tumors. Our results indicate that evaluation of a limited set of adverse histologic features allows for the separation of disseminated mucinous neoplasms of appendiceal origin into three morphologically defined and prognostically relevant grades as advocated by the AJCC.

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“…Sugarbaker et al [20] reported radiological response rate of 44% progression free survival of 6.9 months, and 50% progressive disease. Sugarbaker et al [21] analyzed the role of FOLFOX4 neoadjuvant chemotherapy, and reported 29% objective response rate; but there was also 50% progression. However neoadjuvant chemotherapy is considered a poor prognostic factor regarding progression free survival and overall survival [22].…”

Section: Discussionmentioning

confidence: 99%

Outcome of Management of Pseudomyxoma Peritonei: National Cancer Institute Experience

Gad¹,

Nassar²,

Soliman³

et al. 2018

JCT

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Background: The current treatment for pseudomyxoma peritonei (PMP) consists of radical cytoreductive surgery (CRS) followed by hyperthermic intra-peritoneal chemotherapy (HIPEC). Aim: To assess PMP patients regarding the clinical and pathological characteristics, the treatment including surgery (CRS) and chemotherapy either HIPEC type or post-operative systemic chemotherapy aiming to evaluate end results regarding recurrence and survival. Patients and Methods: This retrospective study included 39 patients with PMP who were diagnosed, treated and followed-up from 2009-2014 at National Cancer Institute, Cairo, Egypt. Results: High grade mucinous adenocarcinoma was found in 23.1% of patients. Patients with low grade tumor showed higher survival rate compared with patients with high grade disease. The mean operative PCI score (peritoneal cancer index) that was done to all patients who were explored was 15.81. Our study reported success to achieve complete cytoreduction that was combined with HIPEC in 44% of patients who were planned for this modality. Treatment related postoperative grade (3 -5) complications mainly surgery related developed in 17.3 of patients. Operative mortality was 22.2%. The follow up period in our study was quite short (mean 22.9). However the overall survival at the end of the follow up in our study was 48.7%, 1 year survival was 82%, and 2 year survival was 41%. The overall survival in patients treated with CRS and HIPEC was 66.6%, with 1 year and 2 year survival of 91% and 66.6% respectively. Only 2 patients developed recurrent disease during the follow up period. Conclusions: The outcome of PMP treatment process is extremely variable. Combined CRS and HIPEC is considered the best therapeutic approach for patients with PMP. Surgical experience combined with proper patient selection have to be built up together to improve the outcome. That could only be achieved through more centralization of patients' treatment in specialized units or center.

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Neoadjuvant FOLFOX chemotherapy in 34 consecutive patients with mucinous peritoneal carcinomatosis of appendiceal origin

Abstract: In these carcinomatosis patients clinical and CT assessment of response to neoadjuvant chemotherapy seldom provided useful data over this short time period. Intraoperative findings indicated progression in 50% of patients. By histopathology, 29% of patients had a response.

Cited by 91 publications

References 18 publications

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

Guidelines on the Use of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Patients with Peritoneal Surface Malignancy Arising from Colorectal or Appendiceal Neoplasms

Clinicopathologic and molecular analysis of disseminated appendiceal mucinous neoplasms: identification of factors predicting survival and proposed criteria for a three-tiered assessment of tumor grade

Outcome of Management of Pseudomyxoma Peritonei: National Cancer Institute Experience

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