TY - JOUR
T1 - Association of Systemic Chemotherapy Approaches With Outcomes in Appendiceal Peritoneal Metastases
AU - Hanna, David N.
AU - Macfie, Rebekah
AU - Ghani, Muhammad O.
AU - Hermina, Andrew
AU - Mina, Alexander
AU - Cha, Da Eun
AU - Bailey, Christina E.
AU - Cohen, Noah
AU - Labow, Daniel
AU - Golas, Benjamin
AU - Sarpel, Umut
AU - Idrees, Kamran
AU - Magge, Deepa
N1 - Funding Information:
We would like to acknowledge our funding source, the National Cancer Institute (T32CA106183).
Publisher Copyright:
© 2022
PY - 2023/4
Y1 - 2023/4
N2 - Introduction: Many patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal adenocarcinoma peritoneal metastases (APM) undergo preoperative systemic chemotherapy. The primary aim of this study is to evaluate differences in oncologic outcomes among two popular chemotherapy approaches in patients with APM undergoing CRS-HIPEC. Methods: We performed a multicenter retrospective review of patients who underwent CRS-HIPEC for APM due to high or intermediate grade disease between 2013 and 2019. Patients in the total neoadjuvant therapy group (TNT) received 12 cycles of preoperative chemotherapy. Patients in the “sandwich” chemotherapy group (SAND) received six cycles of preoperative chemotherapy with a maximum of six cycles of postoperative chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) defined as months from date of first treatment or surgery, respectively. Results: A total of 39 patients were included in this analysis, with 25 (64%) patients in the TNT group and 14 (36%) patients in the SAND group. Patients in the TNT group had a median OS of 62 mo, while median OS in the SAND group was 45 mo (P = 0.01). In addition, patients in the TNT group had significantly longer RFS compared to the SAND group (35 versus 12 mo, P = 0.03). In a multivariable analysis, TNT approach was independently associated with improved OS and RFS. Conclusions: In this multicenter retrospective analysis, a TNT approach was associated with improved overall and recurrence-free survival compared to a sandwiched chemotherapy approach in patients undergoing CRS-HIPEC for high or intermediate grade APM.
AB - Introduction: Many patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal adenocarcinoma peritoneal metastases (APM) undergo preoperative systemic chemotherapy. The primary aim of this study is to evaluate differences in oncologic outcomes among two popular chemotherapy approaches in patients with APM undergoing CRS-HIPEC. Methods: We performed a multicenter retrospective review of patients who underwent CRS-HIPEC for APM due to high or intermediate grade disease between 2013 and 2019. Patients in the total neoadjuvant therapy group (TNT) received 12 cycles of preoperative chemotherapy. Patients in the “sandwich” chemotherapy group (SAND) received six cycles of preoperative chemotherapy with a maximum of six cycles of postoperative chemotherapy. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS) defined as months from date of first treatment or surgery, respectively. Results: A total of 39 patients were included in this analysis, with 25 (64%) patients in the TNT group and 14 (36%) patients in the SAND group. Patients in the TNT group had a median OS of 62 mo, while median OS in the SAND group was 45 mo (P = 0.01). In addition, patients in the TNT group had significantly longer RFS compared to the SAND group (35 versus 12 mo, P = 0.03). In a multivariable analysis, TNT approach was independently associated with improved OS and RFS. Conclusions: In this multicenter retrospective analysis, a TNT approach was associated with improved overall and recurrence-free survival compared to a sandwiched chemotherapy approach in patients undergoing CRS-HIPEC for high or intermediate grade APM.
KW - Appendiceal adenocarcinoma
KW - Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
KW - Neoadjuvant chemotherapy
KW - Peritoneal carcinomatosis
KW - Systemic chemotherapy
UR - http://www.scopus.com/inward/record.url?scp=85146975487&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2022.10.085
DO - 10.1016/j.jss.2022.10.085
M3 - Article
C2 - 36563453
AN - SCOPUS:85146975487
SN - 0022-4804
VL - 284
SP - 94
EP - 100
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -