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Peritoneal Surface Malignancies

P52: Updated Report of a Randomized Trial for Appendiceal Neoplasm Ten Years After Cytoreduction and HIPEC With Mitomycin vs. Oxaliplatin

Introduction: Appendiceal cancer is a rare disease that has proven difficult to study in prospective trials. Our initial report showed minor hematologic toxicity with both Mitomycin and Oxaliplatin and similar 3-year overall and disease-free survival. We now report an update with 10 year follow up. 

Methods: Patients with mucinous appendiceal neoplasms and evidence of peritoneal dissemination were enrolled in the Multicenter Randomized Trial to evaluating HIPEC with Oxaliplatin or Mitomycin. Overall survival and disease free survival were calculated at 10 years and compared between the groups.

Results:

121 patients were included in the study. The patients were 57% female, with a mean age of 55.3 years (range 22 to 82 years). The disease was low grade in 77% and high grade in 23%. The average peritoneal carcinomatosis index (PCI) score was 18 (SD=10) in the Mitomycin group and 17.9 (SD=9.4) in the Oxaliplatin group; p=0.94. The resection status in the Mitomycin group was R0=21%, R1=33%, R2a=39% and R2b=7%; in the Oxaliplatin group R0=23.3%, R1=38.3%, R2a=25%, R2b=10% and R2c=3.3%; p=0.35. The 10-year survival rate was 56.2% (SE 7.2) with Mitomycin and 47.5% (SE 8.4) with Oxaliplatin; p=0.83. The 10-year progression free survival rate in the Mitomycin group was 45.2% (SE 8.4) compared to 50.4% (SE 6.7) in the Oxaliplatin group, p=0.95. Median survival was 9.1 years after HIPEC with oxaliplatin, and median not reached for the Mitomycin group ( >5.6 years).

Conclusions: Oxaliplatin and Mitomycin have similar long-term efficacy for HIPEC in patients with appendiceal neoplasms and peritoneal dissemination. Long term survival is experienced by most patients after CRS and HIPEC for appendiceal neoplasms. 

Learning Objectives:

  • Describe outcomes of Cytoreduction and HIPEC for appendiceal neoplasms
  • Compare outcomes of HIPEC with Oxaliplatin versus Mitomycin C in patients with appendiceal neoplasms
  • List long term survival rates for appendiceal neoplasm after treatment with HIPEC and cytoreduction