This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Culliford, A. T. Articles by Paty, P. B. Search for Related Content PubMed PubMed Citation Articles by Culliford, A. T., IV Articles by Paty, P. B. Related Collections Surgery

Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer

From the Colorectal Service, Department of Surgery (ATC, ADB, JGG, WDW, PBP), the Division of Medical Oncology, Department of Medicine (SS, LBS, GKS, EMO, DHI, NEK, DPK), Memorial Sloan-Kettering Cancer Center, New York, New York, and the Lucille P. Markey Cancer Center (AMC), University of Kentucky.

Correspondence: Address correspondence and reprint requests to: Philip B. Paty, MD, Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021; Fax: 212-717-3678; E-mail: patyp{at}mskcc.org

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.

Key Words: Colon cancer • Appendix cancer • Intraperitoneal chemotherapy • Cytoreduction

This article has been cited by other articles:

				J. M. Logan-Collins, A. M. Lowy, T. M. Robinson-Smith, S. Kumar, J. J. Sussman, L. E. James, and S. A. Ahmad VEGF Expression Predicts Survival in Patients with Peritoneal Surface Metastases from Mucinous Adenocarcinoma of the Appendix and Colon Ann. Surg. Oncol., March 1, 2008; 15(3): 738 - 744. [Abstract] [Full Text] [PDF]

				E. A. Levine, B. M. Ronnett, P. F. Mansfield, and C. Eng Overview of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Dissemination of Appendiceal and Colorectal Neoplasms ASCO Educational Book, January 1, 2008; 2008(1): 153 - 159. [Abstract] [Full Text] [PDF]

				S. Varghese, M. Burness, H. Xu, T. Beresnev, J. Pingpank, and H. R. Alexander Site-Specific Gene Expression Profiles and Novel Molecular Prognostic Factors in Patients with Lower Gastrointestinal Adenocarcinoma Diffusely Metastatic to Liver or Peritoneum Ann. Surg. Oncol., December 1, 2007; 14(12): 3460 - 3471. [Abstract] [Full Text] [PDF]

				F. Aarts, T. Hendriks, O. C. Boerman, M. J. Koppe, W. J. G. Oyen, and R. P. Bleichrodt A Comparison Between Radioimmunotherapy and Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Peritoneal Carcinomatosis of Colonic Origin in Rats Ann. Surg. Oncol., November 1, 2007; 14(11): 3274 - 3282. [Abstract] [Full Text] [PDF]

				T. D. Yan, J. Sim, and D. L. Morris Selection of Patients with Colorectal Peritoneal Carcinomatosis for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Ann. Surg. Oncol., June 1, 2007; 14(6): 1807 - 1817. [Abstract] [Full Text] [PDF]

				F. Aarts, M. J. Koppe, T. Hendriks, J. E. M. vanEerd, W. J. G. Oyen, O. C. Boerman, and R. P. Bleichrodt Timing of Adjuvant Radioimmunotherapy after Cytoreductive Surgery in Experimental Peritoneal Carcinomatosis of Colorectal Origin Ann. Surg. Oncol., February 1, 2007; 14(2): 533 - 540. [Abstract] [Full Text] [PDF]

				J. H. Stewart IV, P. Shen, G. B. Russell, R. F. Bradley, J. C. Hundley, B. L. Loggie, K. R. Geisinger, and E. A. Levine Appendiceal Neoplasms With Peritoneal Dissemination: Outcomes After Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy Ann. Surg. Oncol., May 1, 2006; 13(5): 624 - 634. [Abstract] [Full Text] [PDF]

				J. H. Stewart IV, P. Shen, and E. A. Levine Intraperitoneal Hyperthermic Chemotherapy for Peritoneal Surface Malignancy: Current Status and Future Directions Ann. Surg. Oncol., October 1, 2005; 12(10): 765 - 777. [Abstract] [Full Text] [PDF]

				O. Glehen, F. Kwiatkowski, P.H. Sugarbaker, D. Elias, E.A. Levine, M. De Simone, R. Barone, Y. Yonemura, F. Cavaliere, F. Quenet, et al. Cytoreductive Surgery Combined With Perioperative Intraperitoneal Chemotherapy for the Management of Peritoneal Carcinomatosis From Colorectal Cancer: A Multi-Institutional Study J. Clin. Oncol., August 15, 2004; 22(16): 3284 - 3292. [Abstract] [Full Text] [PDF]

				S. A. Ahmad, J. Kim, J. J. Sussman, D. A. Soldano, L. J. Pennington, L. E. James, and A. M. Lowy Reduced Morbidity Following Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemoperfusion Ann. Surg. Oncol., April 1, 2004; 11(4): 387 - 392. [Abstract] [Full Text] [PDF]

				V. J. Verwaal, S. van Ruth, E. de Bree, G. W. van Slooten, H. van Tinteren, H. Boot, and F. A.N. Zoetmulder Randomized Trial of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy Versus Systemic Chemotherapy and Palliative Surgery in Patients With Peritoneal Carcinomatosis of Colorectal Cancer J. Clin. Oncol., October 15, 2003; 21(20): 3737 - 3743. [Abstract] [Full Text] [PDF]

				A. M. Lowy Surgery as Adjuvant Therapy? The Treatment of Peritoneal Metastases From Gastrointestinal Malignancy Ann. Surg. Oncol., December 1, 2001; 8(10): 754 - 755. [Full Text] [PDF]