ABSTRACT
In this chapter, the authors review the available literature and hope to provide insight on role of systemic therapy for appendiceal cancer. They explain preoperative and neoadjuvant are synonymous terms, as is postoperative and adjuvant with regard to systemic chemotherapy/biologic therapy. A majority of patients who are deemed resectable at diagnosis proceed to receive cytoreductive surgery (CS) and hyper-thermic intraperitoneal chemotherapy (HIPEC). Of the few studies that do exist, most are retrospective reviews, with a small sample size of very heterogeneous patients who may have received systemic chemotherapy/biologic therapy preoperatively/neoadjuvant, postoperative/adjuvant, or both. The authors show hat there is a limited role for perioperative systemic chemotherapy in patients with low-grade appendiceal mucinous carcinoma peritonei (MCP) treated with CS/HIPEC. In patients with high-grade appendiceal MCP, preoperative chemotherapy should be reserved for patients who are borderline–resectable or nonresectable. In the low-grade appendiceal MCP, 22 patients were treated with perioperative chemotherapy, 13 patients received preoperative systemic chemotherapy, and 9 patients received postoperative chemotherapy.
