Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer Journal Article

Authors: Culliford, A. T. 4th; Brooks, A. D.; Sharma, S.; Saltz, L. B.; Schwartz, G. K.; O'Reilly, E. M.; Ilson, D. H.; Kemeny, N. E.; Kelsen, D. P.; Guillem, J. G.; Wong, W. D.; Cohen, A. M.; Paty, P. B.
Article Title: Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer
Abstract: Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome. Methods: Patients having surgical debulking and IP 5-fluoro-2′-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively. Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m2 daily for 3 days) and IP leucovorin (240 mg/m2) with a median cycle number of 4 (range, 1-28). The median number of complications was 1 (range, 0-5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0-132 months). The median survival was 34 months (range, 2-132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection. Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.
Keywords: adolescent; adult; aged; middle aged; survival analysis; survival rate; retrospective studies; major clinical study; mortality; fluorouracil; patient selection; combined modality therapy; lymph node metastasis; cancer grading; adenocarcinoma; peritoneal neoplasms; antimetabolites, antineoplastic; antineoplastic combined chemotherapy protocols; colonic neoplasms; irinotecan; folinic acid; colon cancer; multivariate analysis; cytoreduction; floxuridine; peritoneum metastasis; leucovorin; infusions, parenteral; intraperitoneal chemotherapy; appendix cancer; appendiceal neoplasms; humans; prognosis; human; male; female; article; formyltetrahydrofolates
Journal Title: Annals of Surgical Oncology
Volume: 8
Issue: 10
Dates: 2001 Mar 15-18
Location: Washington, DC
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2001-12-01
Start Page: 787
End Page: 795
Language: English
DOI: 10.1007/s10434-001-0787-9
PUBMED: 11776492
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus
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MSK Authors
  1. Leonard B Saltz
    599 Saltz
  2. Gary Schwartz
    364 Schwartz
  3. Philip B Paty
    373 Paty
  4. Sunil Sharma
    26 Sharma
  5. Ari D Brooks
    25 Brooks
  6. Jose Guillem
    373 Guillem
  7. Alfred M Cohen
    175 Cohen
  8. David H Ilson
    275 Ilson
  9. Eileen O'Reilly
    324 O'Reilly
  10. Douglas W Wong
    173 Wong
  11. David P Kelsen
    341 Kelsen
  12. Nancy Kemeny
    358 Kemeny