P. Lu1,2, G. Shabat1,3, A. C. Fields1, R. Bleday1, J. Goldberg1, N. Melnitchouk1,2 1Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 2Center for Surgery and Public Health,Brigham And Women’s Hospital,Boston, MA, USA 3Ivano-Frankivsk National Medical University,Department Of Surgery,Ivano-Frankivsk, IVANO-FRANKIVSK, Ukraine
Introduction: Appendiceal cancer is a rare malignancy that exhibits a wide range of histology and treatment response. Studies have suggested that while cytoreductive surgery with intraperitoneal chemotherapy can improve survival, there is little efficacy in systemic chemotherapy use for metastatic mucinous appendiceal adenocarcinoma with low grade histology. It is posited that the indolent, slow growing nature of low grade disease diminishes the effect of cell cycle based systemic chemotherapy regimens. No guidelines currently exist for treatment of appendiceal cancers. Despite lack of evidence, the use of systemic chemotherapy in low grade metastatic mucinous appendiceal adenocarcinoma continues to vary. We evaluated the treatment of patients with metastatic low grade mucinous appendiceal adenocarcinoma at two large cancer referral centers.
Methods: Patients diagnosed with metastatic low grade mucinous adenocarcinoma at two cancer referral centers between the years 2000 and 2017 were identified. Chart review was performed and information regarding patient demographics, cancer specific details, perioperative outcomes, and treatment histories were collected, and descriptive statistics were performed
Results: 94 patients had mucinous, histologically low grade, stage IV appendiceal adenocarcinoma. Of these patients, a total of 93.6% of patients underwent at least 1 surgery for cytoreduction, and 51.1% of patients successfully completed hyperthermic intraperitoneal chemotherapy. 6.4% of patients underwent systemic chemotherapy treatment prior to surgery- the regimens included FOLFOX, Capecitabine, or combination. After surgery, a large subset of patients underwent additional chemotherapy. Many of them went on to receive multiple different lines of systemic treatment and experienced a wide range of chemotherapy related complications including neuropathy, fatigue, gastrointestinal distress, and neutropenia (Table 1). Chemotherapy treatments were highly variable as well. The most frequently used regimens were CAPOX, FOLFOX, or 5FU regimens with or without Bevacizumab.
Conclusion: Despite lack of evidence supporting the use of systemic chemotherapy in treatment of metastatic low grade mucinous appendiceal adenocarcinoma, a large proportion of patients received variable systemic chemotherapy regimens and experienced related adverse effects.
