Systemic chemotherapy in appendiceal adenocarcinomas with peritoneal metastases: Is it worth it?

Abstract

espanolIntroduccion El papel de la quimioterapia sistemica (SC) en el tratamiento de los adenocarcinomas apendiculares metastasicos no esta definido. Metodos Realizamos un estudio observacional de pacientes tratados con metastasis peritoneales de neoplasma apendicular entre junio de 2004 y diciembre de 2017. Fueron remitidos a nuestro hospital para HIPEC de CRS. Los regimenes de quimioterapia sistemica fueron decididos por el oncologo referente. Analizamos PCI, CC, y uso de SC. La supervivencia global y la supervivencia libre de progresion se compararon atendiendo al subtipo histologico (adenocarcinomas de grado alto y bajo) y al uso de SC. Resultados Se incluyeron 60 pacientes, 26 eran hombres, mediana de edad 63 anos (26-81). Mediana de seguimiento de 38 meses [2-155]. El subtipo histologico predominante fue el adenocarcinoma mucinoso (58/60), 1 fue de tipo colonico y 1 adenocarcinoide con celulas en anillo de sello. Cuatro pacientes tuvieron metastasis extraperitoneales, 2 metastasis hepaticas (1 con adenocarcinoma mucinoso de alto grado y 1 con adenocarcinoma de colon) y 2 en el grupo de bajo grado desarrollaron enfermedad pulmonar parenquimatosa. Tres pacientes fallecieron en el postoperatorio. Se administro quimioterapia sistemica en 26 pacientes / 57. No se observaron diferencias en el sistema operativo y PFS, independientemente del uso de SC en los grupos de grado alto y alto. Conclusiones El uso de SC en el subtipo de adenocarcinoma mucinoso de bajo grado no esta respaldado por nuestros resultados, y no hay datos publicados que lo respalden. El SC paliativo en pacientes de alto grado merece los ensayos clinicos por haber sido aceptado como estandar de atencion, cuando los beneficios no estan claramente establecidos por la evidencia y las toxicidades no son despreciables. EnglishIntroduction The role of systemic chemotherapy (SC) in the management of metastatic appendiceal adenocarcinomas is not defined. Methods We perform an observational study of patients treated of peritoneal metastases from appendiceal neoplasm between June 2004 and December 2017. They were referred to our hospital for CRS HIPEC. Systemic Chemotherapy regimens were decided by the referring oncologist. We analyze PCI, CC, and use of SC. Overall survival and progression free survival were compared attending to histologic subtype (high- and low-grade adenocarcinomas) and the use of SC. Results 60 patients were included, 26 were male, median age 63 years (26-81). Median follow-up of 38 months [2-155]. The predominant histologic subtype was mucinous adenocarcinoma (58/60), 1 was colonic type, and 1 adenocarcinoid with signet ring cells. Four patients had extraperitoneal metastases, 2 hepatic metastases (1 with high-grade mucinous adenocarcinoma and 1 with colonic adenocarcinoma), and 2 in the low-grade group developed parenchymal lung disease. Three patients died in the postoperative period. Systemic chemotherapy was administered in 26 patients/57. No difference were observed in the OS and PFS regardless the use of SC in the high- and in the lo-grade groups. Conclusions The use of SC in low-grade mucinous adenocarcinoma subtype is not supported by our results, and there is no literature date supporting it neither. Palliative SC in high-grade patients deserves of clinical trials for been accepted as standard of care, when benefits are not clearly established by evidence and toxicities are not negligible.