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Impact of neoadjuvant systemic chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal adenocarcinoma

Impact of neoadjuvant systemic chemotherapy followed by cytoreductive surgery and hyperthermic... INTRODUCTIONAppendiceal epithelial tumors are rare, accounting for approximately .5%–1% of gastrointestinal neoplasms.1 They display explicit heterogeneity in histological subtype, which largely determines prognosis. About 25% exhibit invasive (rather than “pushing”) features and upon perforation of the primary lesion have a high propensity for peritoneal dissemination as well as systemic metastases.2In the past, the traditional approach of operative debulking for patients with metastatic infiltrative appendiceal malignancies led to 5‐year overall survival (OS) of 6%.3 Following the inception of cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and indeed modern systemic chemotherapy regimens, 5‐year survival for these patients has improved to 50%–67%.4–6 CRS and HIPEC are currently performed at nine centers across Australia and New Zealand, but given the rarity of these tumors, the opportunity to report on these invasive subtypes, from an Australasian perspective, has been limited. One such center in Sydney has reported a 5‐year OS of 42%, which was published as part of an institutional experience in the operative management of peritoneal surface malignancy.7The administration of neoadjuvant systemic chemotherapy (NAC) prior to CRS for isolated, resectable disease is controversial. Potential advantages include assessing tumor biology and patient selection for surgery, and reduction of tumor volume, which may lead to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia-Pacific Journal of Clinical Oncology Wiley

Impact of neoadjuvant systemic chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal adenocarcinoma

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Publisher
Wiley
Copyright
© 2023 John Wiley & Sons Australia, Ltd.
ISSN
1743-7555
eISSN
1743-7563
DOI
10.1111/ajco.13949
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONAppendiceal epithelial tumors are rare, accounting for approximately .5%–1% of gastrointestinal neoplasms.1 They display explicit heterogeneity in histological subtype, which largely determines prognosis. About 25% exhibit invasive (rather than “pushing”) features and upon perforation of the primary lesion have a high propensity for peritoneal dissemination as well as systemic metastases.2In the past, the traditional approach of operative debulking for patients with metastatic infiltrative appendiceal malignancies led to 5‐year overall survival (OS) of 6%.3 Following the inception of cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and indeed modern systemic chemotherapy regimens, 5‐year survival for these patients has improved to 50%–67%.4–6 CRS and HIPEC are currently performed at nine centers across Australia and New Zealand, but given the rarity of these tumors, the opportunity to report on these invasive subtypes, from an Australasian perspective, has been limited. One such center in Sydney has reported a 5‐year OS of 42%, which was published as part of an institutional experience in the operative management of peritoneal surface malignancy.7The administration of neoadjuvant systemic chemotherapy (NAC) prior to CRS for isolated, resectable disease is controversial. Potential advantages include assessing tumor biology and patient selection for surgery, and reduction of tumor volume, which may lead to

Journal

Asia-Pacific Journal of Clinical OncologyWiley

Published: Mar 7, 2023

Keywords: appendiceal cancer; cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; neoadjuvant chemotherapy

References