Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

Chapter 37•Peritoneal Carcinomatosis 493

Answer 37.7. The answer is E.

DPAM includes peritoneal tumors with scant cellularity in the presence of

abundant extracellular mucin. Endothelial cells present are histologically

bland with low-grade adenomatous features, minimal cytologic atypia,

and low mitotic activity.

Answer 37.8. The answer is A.

In the series of 65 patients from Ronnet et al. (Cancer. 2001;92) and a

review of 62 patients with pseudomyxoma peritonei by van Ruth et al.

(Eur J Surg Oncol. 2003;29), median survival was significantly improved

in patients with DPAM who were treated with maximal tumor debulking

followed by intraperitoneal mitomycin C alone or in combination with

5FU. Three additional cycles of systemic 5FU/mitomycin C chemotherapy

were given to all patients in the Ronnet series but was reserved only for

patients with pathological evidence of malignancy in the van Ruth series.

Both approaches appear to confer similar survival outcomes.

Answer 37.9. The answer is A.

In mucinous adenocarcinoma of the appendix, histologic grade is the

single most important prognostic indicator, with high-grade histologic

atypia associated with the poorest outcome. In a series of 94 consecutive

patients with adenocarcinoma of the appendix, the presence of high-grade

“colonic type” tumors was reported in 45% of patients and was associ-

ated with higher grade tumors and higher stage, and ultimately poorer

prognosis when compared with benign mucinous tumors (Nitecki et al.

Ann Surg. 1994;219).

Answer 37.10. The answer is B.

Data regarding adjuvant intraperitoneal chemotherapy for high-risk

tumors have been mixed. Yu et al. (Ann Surg. 1998;64) randomized 248

patients with stage II and III gastric cancer to surgical resection alone ver-

sus resection plus postoperative intraperitoneal mitomycin C and 5FU,

with an increase in survival seen only in the subset of patients with stage

III cancer. Other series of similar patients using intraperitoneal cisplatin or

mitomycin C did not show statistically significant improvements in local

control or survival, except in patients with serosal invasion by tumors

(Sautner et al. J Clin Oncol. 1994;12; Ikeguchi et al. Eur J Surg. 1995;161).

Answer 37.11. The answer is D.

When complete resection of the primary tumor along with all peritoneal

disease is not possible, surgical intervention merely delays the inevitable

need for intravenous chemotherapy. Complete surgical cytoreduction was

achieved in only 43% of the cases in one series. Compared with patients

with complete surgical debulking, those without total resection of the

primary and intraperitoneal disease fare much worse regardless of the

use of hyperthermic intraperitoneal chemoperfusion.