Health-Related Quality of Life After Cytoreductive Surgery/HIPEC for Mucinous Appendiceal Cancer: Results of a Multicenter Randomized Trial Comparing Oxaliplatin and Mitomycin

Background This study evaluated health-related quality of life (HRQOL) using patient-reported outcomes in subjects with mucinous appendiceal neoplasms who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as part of a randomized trial comparing mitomycin wi...

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Veröffentlicht in:Annals of surgical oncology Jg. 27; H. 3; S. 772 - 780
Hauptverfasser: Moaven, Omeed, Votanopoulos, Konstantinos I., Shen, Perry, Mansfield, Paul, Bartlett, David L., Russell, Greg, McQuellon, Richard, Stewart, John H., Levine, Edward A.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Cham Springer International Publishing 01.03.2020
Springer Nature B.V
Schlagworte:
Adenocarcinoma, Mucinous - secondary
Adenocarcinoma, Mucinous - therapy
Adult
Aged
Aged, 80 and over
Antineoplastic Agents - adverse effects
Antineoplastic Agents - therapeutic use
Appendiceal Neoplasms - pathology
Appendiceal Neoplasms - therapy
Appendix
Cancer
Chemotherapy
Combined Modality Therapy
Cytoreduction Surgical Procedures
Female
Gastrointestinal cancer
Health Status
Humans
Hyperthermia, Induced
Male
Medicine
Medicine & Public Health
Middle Aged
Mitomycin
Mitomycin - adverse effects
Mitomycin - therapeutic use
Neurotoxicity
Oncology
Oxaliplatin
Oxaliplatin - adverse effects
Oxaliplatin - therapeutic use
Patient Reported Outcome Measures
Perfusion
Peritoneal Neoplasms - secondary
Peritoneal Neoplasms - therapy
Peritoneal Surface Malignancy
Peritoneum
Prospective Studies
Quality of Life
Questionnaires
Surgery
Surgical Oncology
Survival
Survival Rate
Well being
Young Adult
ISSN:1068-9265, 1534-4681, 1534-4681
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Zusammenfassung:Background This study evaluated health-related quality of life (HRQOL) using patient-reported outcomes in subjects with mucinous appendiceal neoplasms who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as part of a randomized trial comparing mitomycin with oxaliplatin. Methods In this prospective multicenter study, 121 mucinous appendiceal cancer patients, with evidence of peritoneal dissemination who underwent CRS, were randomized to receive mitomycin (divided 40 mg) or oxaliplatin (200 mg/m 2 ) for HIPEC. The Functional Assessment of Cancer Therapy Neurotoxicity (FACT-G/NTX) questionnaire was utilized to assess HRQOL. The Trial Outcome Index (TOI) is a summary index responsive to changes in physical/functional outcomes. Repeated measures mixed models with an unstructured variance matrix were applied to assess changes in HRQOL longitudinally. Results Baseline questionnaire compliance was 95.9%. Baseline physical well-being (PWB) was independently associated with overall survival (hazard ratio 0.79, 95% confidence interval 0.66–0.96; p  = 0.017). The TOI was significantly lower in the mitomycin group compared with the oxaliplatin arm at 12 weeks ( p  = 0.044; score difference 6.35) and 24 weeks after surgery ( p  = 0.049; score difference 5.61). At 12 weeks after surgery, declines from baseline were significant in the TOI ( p  = 0.004; score decline 8.99), PWB ( p  < 0.001; score decline 2.83), and FWB ( p  < 0.001; score decline 3.42) in the mitomycin group but not the oxaliplatin group. Conclusions Compared with mitomycin, HIPEC perfusion with oxaliplatin results in significantly better physical and functional outcomes. With similar survival outcomes and complication rates, oxaliplatin should be considered as the chemoperfusion agent of choice in mucinous appendiceal cancer patients undergoing CRS/HIPEC.
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ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-019-08064-6