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Utility of Neoadjuvant Chemotherapy for Peritoneal Carcinomatosis Secondary to High-Grade Appendiceal Neoplasms for Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Neoadjuvant chemotherapy (NAT) is frequently utilized before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for high-grade appendiceal neoplasms. The proposed benefits of NAT do not correlate with the limited literature.

Methods

Retrospective review of our CRS-HIPEC registry. Primary outcomes were the effect of NAT on disease burden, cytoreduction scores, overall survival (OS), disease-free survival (DFS), and recurrence patterns.

Results

A total of 126 cases of high-grade disease met selection criteria; 73 cases received NAT before referral, and 53 cases received no therapy before referral and went directly to CRS-HIPEC. For those cases who received NAT 89% received a FOLFOX-based regimen. Mean PCI scores were 16.47 and 16.07 (P = 0.843) with complete cytoreductions rates of 79.5% and 75% (P = 0.556) for NAT and non-NAT cases, respectively. NAT cases were associated with significantly decreased OS and DFS rates. Mean OS was 3.6 and 2.5 years (P = 0.005) with actual 5-year OS rates of 24.2% versus 5% (P = 0.017) for non-NAT and NAT cases respectively. Mean DFS was 2.8 and 1.7 years (P = 0.015) with actual 5-year DFS rates of 18.6% versus 5.7% (P = 0.048) for non-NAT and NAT cases respectively. Lastly, the use of NAT had no impact on recurrence patterns (P = 0.221).

Conclusions

This is the largest study to evaluate high-grade appendiceal neoplasms in regard to CRS-HIPEC and NAT. NAT had no impact in regard to disease burden, cytoreduction, or recurrence patterns. Utilization of NAT was associated with decreased OS and DFS.

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Authors and Affiliations

  1. Division of Surgical Oncology, Wake Forest Baptist Health Medical Center, Winston-Salem, USA

    Christopher W. Mangieri MD, Cristian D. Valenzuela MD, Richard A. Erali MD, Konstantinos I. Votanopoulos MD, PhD, Perry Shen MD & Edward A. Levine MD

  2. Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA

    Omeed Moaven MD

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  1. Christopher W. Mangieri MD
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  2. Omeed Moaven MD
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  3. Cristian D. Valenzuela MD
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  5. Konstantinos I. Votanopoulos MD, PhD
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  7. Edward A. Levine MD
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Correspondence to Christopher W. Mangieri MD.

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Mangieri, C.W., Moaven, O., Valenzuela, C.D. et al. Utility of Neoadjuvant Chemotherapy for Peritoneal Carcinomatosis Secondary to High-Grade Appendiceal Neoplasms for Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 29, 2641–2648 (2022). https://doi.org/10.1245/s10434-021-11153-0

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