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IS NEOADJUVANT CHEMOTHERAPY BEFORE CYTOREDUCTION ASSOCIATED WITH IMPROVED SURVIVAL IN APPENDICEAL/COLORECTAL ADENOCARCINOMA WITH PERITONEAL METASTASES?
Stephanie Young*1,2, Siu-Yuan Huang2, Melanie Goldfarb1, Victoria O'Connor2, Anna Leung2
1John Wayne Cancer Institute, Santa Monica, CA; 2Kaiser Permanente Southern California, Los Angeles, CA

Objective: Investigate the association of neoadjuvant chemotherapy (NAC) and survival in patients with appendiceal or colorectal adenocarcinoma with peritoneal metastasis (PM) undergoing cytoreductive surgery (CRS).
Background: Randomized trials have demonstrated improved survival in patients undergoing CRS for PM. However, there is a paucity of data regarding benefit of NAC prior to CRS.
Methods: Retrospective single-institution study of patients with appendiceal or colorectal adenocarcinoma with PM who underwent CRS between 02/2017 through 08/2021. Patients were grouped by administration of NAC. Primary outcomes included overall survival (OS) and disease-specific survival (DSS).
Results: Among 61 patients in the study period, 37 patients (60.7%) received NAC with an average of 10 cycles. Median postoperative follow-up was 17.9 months. Patients with a colorectal primary (P<0.0001), moderately differentiated tumor biology (P<0.0001), presence of ascites on preoperative imaging (P<0.0009), or omental thickening (P<0.043) were more likely to receive NAC. Patients that received NAC were more likely to have complete cytoreduction (83.8% vs 58.3%, P=0.027) and lower median peritoneal carcinomatosis index (PCI) scores (7 vs 23, P=0.005). However, NAC was not associated with improvement in short-term OS or DSS; 1-year OS and DSS were equivalent at 90.3% NAC vs 100% without NAC. Subgroup analyses for patients with complete cytoreduction, low PCI, or more favorable tumor biology did not have improved OS or DSS with NAC.
Conclusions: The administration of preoperative chemotherapy in patients with appendiceal and colorectal adenocarcinoma with PM undergoing CRS may be associated with improved oncologic outcomes, including lower PCI scores and an increased rate of complete cytoreduction. However, this does not seem to translate into improved short-term survival outcomes; longer follow-up may be needed to see any survival advantage.


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