Ten-Year Outcome of a Randomized Trial: Cytoreduction and HIPEC with Mitomycin C Versus Oxaliplatin for Appendiceal Neoplasm with Peritoneal Dissemination

Edward A. Levine MD, Heidy Cos MD, Konstantinos I. Votanopoulos MD, PhD, Perry Shen MD, Greg Russell MS, Paul Mansfield MD, Keith Fournier MD, David Bartlett MD & John H. Stewart MD, MBA

Annals of Surgical Oncology

In an article reporting 10-year outcome updates on a 2019 study, researchers have shown that patients with appendiceal cancer undergoing cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) experience significant long-term survival benefits. The research compared two chemotherapy agents used during HIPEC—mitomycin C and oxaliplatin—and found their efficacy to be similar. Notably, over half of the patients treated with mitomycin C and nearly half treated with oxaliplatin were still alive after ten years.

This study underscores the similar effectiveness of both mitomycin C and oxaliplatin and demonstrates the long-term efficacy of CRS/HIPEC in managing appendiceal cancer, offering hope for extended survival.

A summary of the findings are provided below. Read the full article here.

Background

Appendiceal cancer is a rare type of cancer that spreads to the abdominal lining in some patients. Treating this cancer often involves a specialized procedure called Cytoreductive Surgery (CRS) combined with heated chemotherapy (HIPEC). This study followed patients for 10 years to compare two types of chemotherapy used during HIPEC: mitomycin C and oxaliplatin.

Who Participated

A total of 121 patients with appendiceal cancer that had spread to the abdominal lining took part in the study. They were, on average, 55 years old, and 57% were women. About 71% of the patients had low-grade cancer, meaning it typically grows more slowly, while 29% had high-grade cancer, which tends to grow more aggressively.

Key Findings

Survival: After 10 years, 56% of patients who received mitomycin C were still alive, compared to 47% of those who received oxaliplatin. The difference between the two groups was not significant.
Cancer Progression: The cancer did not return in 45% of patients treated with mitomycin C and in 50% of those treated with oxaliplatin.
Long-Term Survival: Most patients experienced long-term survival, with a median survival of over 9 years for the oxaliplatin group. The median survival for the mitomycin C group was even longer, but the exact number is unknown because many were still alive at the study's end.

Conclusion

Both mitomycin C and oxaliplatin are effective options for HIPEC in patients with appendiceal cancer. Importantly, many patients achieved long-term survival with this treatment. This study provides hope and valuable information for patients considering CRS and HIPEC as a treatment option.