Annals of Surgical Oncology Sign the Guestbook
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
10.1245/s10434-006-9174-x
Annals of Surgical Oncology 14:493-499 (2007)
© 2007 Society of Surgical Oncology
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Smeenk, R. M.
Right arrow Articles by Zoetmulder, F. A. N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Smeenk, R. M.
Right arrow Articles by Zoetmulder, F. A. N.

Original Article

Progression of Pseudomyxoma Peritonei after Combined Modality Treatment: Management and Outcome

Robert M. Smeenk, MD1, Vic J. Verwaal, MD, PhD1, Ninja Antonini, MSc2 and Frans A. N. Zoetmulder, MD, PhD1

1 Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
2 Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands

Correspondence: Address correspondence and reprint requests to: Vic J. Verwaal, MD, PhD; E-mail: v.verwaal{at}nki.nl

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.

Key Words: Pseudomyxoma peritonei • Cytoreduction • HIPEC • Progression • Management Outcome




This article has been cited by other articles:


Home page
 Ann. Surg. Oncol.Home page
T. D. Yan, M. Links, S. Fransi, T. Jacques, D. Black, V. Saunders, and D. L. Morris
Learning Curve for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Peritoneal Surface Malignancy A Journey to Becoming a Nationally Funded Peritonectomy Center
Ann. Surg. Oncol., August 1, 2007; 14(8): 2270 - 2280.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the Society of Surgical Oncology.