Progression of pseudomyxoma peritonei after combined modality treatment : management and outcome
(2007) In Annals of Surgical Oncology 14(2). p.9-493- Abstract
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment strategy for pseudomyxoma peritonei (PMP) with curative intent. The aim of this study was to determine the patterns of failure in patients who underwent such a procedure and to evaluate management and outcome of progressive disease.
METHODS: After exclusion of patients with overt malignancy, progression was studied in 96 PMP patients treated primarily by CRS with HIPEC. Location, pathology, management and outcome were recorded.
RESULTS: Median follow-up was 51.5 months (0.1-99.5). Median progression free survival (PFS) was 28.2 months (95% CI 18.3->). Progressive disease was mainly located sub hepatic (38%) or in... (More)
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment strategy for pseudomyxoma peritonei (PMP) with curative intent. The aim of this study was to determine the patterns of failure in patients who underwent such a procedure and to evaluate management and outcome of progressive disease.
METHODS: After exclusion of patients with overt malignancy, progression was studied in 96 PMP patients treated primarily by CRS with HIPEC. Location, pathology, management and outcome were recorded.
RESULTS: Median follow-up was 51.5 months (0.1-99.5). Median progression free survival (PFS) was 28.2 months (95% CI 18.3->). Progressive disease was mainly located sub hepatic (38%) or in multiple regions (36%). Pathological dedifferentiation was observed in 8 patients (20%). The choice of treatment depended on pathology, extent of disease and PFS. Seventeen patients were treated for progression by second CRS with (n=8) or without HIPEC (n=10). The 3-years overall survival (OS) probability after this treatment was 100% and 53.3% (95% CI 28.2-100%), respectively. Fifteen patients with (slow) progression were observed. Three-years OS probability of these patients was 66.0% (95% CI 43.4-100%). All patients treated for progression by systemic chemotherapy only (n=6) had died of disease after a median follow up of 14.8 (9.8-33.6) months. A longer PFS after primary treatment was associated with longer OS after progression (P = 0.04).
CONCLUSIONS: Progressive PMP after primary CRS with HIPEC is probably the result of technical failure and/or tumor biology. Management of progressive PMP can be valuable for selected patients and should depend primarily on the PFS.
(Less)
- author
- Smeenk, Robert M ; Verwaal, Vic J LU ; Antonini, Ninja and Zoetmulder, Frans A N
- publishing date
- 2007-02
- type
- Contribution to journal
- publication status
- published
- keywords
- Adult, Aged, Antineoplastic Agents/administration & dosage, Combined Modality Therapy, Disease Progression, Female, Humans, Infusions, Parenteral, Male, Middle Aged, Peritoneal Neoplasms/pathology, Peritoneum/surgery, Pseudomyxoma Peritonei/pathology, Retrospective Studies, Survival Analysis, Treatment Failure
- in
- Annals of Surgical Oncology
- volume
- 14
- issue
- 2
- pages
- 9 - 493
- publisher
- Springer
- external identifiers
-
- scopus:33846601358
- pmid:17103067
- ISSN
- 1068-9265
- DOI
- 10.1245/s10434-006-9174-x
- language
- English
- LU publication?
- no
- id
- a6e4b76e-4195-4641-b428-7248622651c1
- date added to LUP
- 2022-04-12 09:54:00
- date last changed
- 2024-03-11 12:29:45
@article{a6e4b76e-4195-4641-b428-7248622651c1,
abstract = {{<p>BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment strategy for pseudomyxoma peritonei (PMP) with curative intent. The aim of this study was to determine the patterns of failure in patients who underwent such a procedure and to evaluate management and outcome of progressive disease.</p><p>METHODS: After exclusion of patients with overt malignancy, progression was studied in 96 PMP patients treated primarily by CRS with HIPEC. Location, pathology, management and outcome were recorded.</p><p>RESULTS: Median follow-up was 51.5 months (0.1-99.5). Median progression free survival (PFS) was 28.2 months (95% CI 18.3->). Progressive disease was mainly located sub hepatic (38%) or in multiple regions (36%). Pathological dedifferentiation was observed in 8 patients (20%). The choice of treatment depended on pathology, extent of disease and PFS. Seventeen patients were treated for progression by second CRS with (n=8) or without HIPEC (n=10). The 3-years overall survival (OS) probability after this treatment was 100% and 53.3% (95% CI 28.2-100%), respectively. Fifteen patients with (slow) progression were observed. Three-years OS probability of these patients was 66.0% (95% CI 43.4-100%). All patients treated for progression by systemic chemotherapy only (n=6) had died of disease after a median follow up of 14.8 (9.8-33.6) months. A longer PFS after primary treatment was associated with longer OS after progression (P = 0.04).</p><p>CONCLUSIONS: Progressive PMP after primary CRS with HIPEC is probably the result of technical failure and/or tumor biology. Management of progressive PMP can be valuable for selected patients and should depend primarily on the PFS.</p>}},
author = {{Smeenk, Robert M and Verwaal, Vic J and Antonini, Ninja and Zoetmulder, Frans A N}},
issn = {{1068-9265}},
keywords = {{Adult; Aged; Antineoplastic Agents/administration & dosage; Combined Modality Therapy; Disease Progression; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Peritoneal Neoplasms/pathology; Peritoneum/surgery; Pseudomyxoma Peritonei/pathology; Retrospective Studies; Survival Analysis; Treatment Failure}},
language = {{eng}},
number = {{2}},
pages = {{9--493}},
publisher = {{Springer}},
series = {{Annals of Surgical Oncology}},
title = {{Progression of pseudomyxoma peritonei after combined modality treatment : management and outcome}},
url = {{http://dx.doi.org/10.1245/s10434-006-9174-x}},
doi = {{10.1245/s10434-006-9174-x}},
volume = {{14}},
year = {{2007}},
}