Does Chemotherapy Before Surgery Help in Advanced Appendix Cancer?

Abdominal Cancers Alliance
Oct 7
2 min read

Updated: Oct 15

Carlos A Munoz-Zuluaga, Mary Caitlin King, Panayotis Ledakis, Vadim Gushchin, Michelle Sittig, Carol Nieroda, Katherine Zambrano-Vera, Armando Sardi

Systemic chemotherapy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) in patients with high-grade mucinous carcinoma peritonei of appendiceal origin. European Journal of Surgical Oncology. 2019 Sep;45(9):1598-1606.

https://pubmed.ncbi.nlm.nih.gov/31109821/

Summary:

Researchers examined whether giving chemotherapy before surgery + HIPEC (heated chemotherapy inside the abdomen) helps people with high-grade appendiceal cancer that has spread to the lining of the abdomen (mucinous carcinoma peritonei). They found that pre-surgery chemo did not improve survival or delay recurrence, and did not make the surgery more effective.

Background

In advanced appendix cancer, one standard treatment is cytoreductive surgery + HIPEC, which aims to remove as much tumor as possible and treat remaining cancer cells locally. Some doctors also give chemo beforehand (called neoadjuvant chemo) in hopes of shrinking disease and improving outcomes. But it hasn’t been clear whether that extra step is beneficial for this kind of tumor.

What Was Done

The authors used a database of patients treated from 1998 to 2017.
They looked at 140 patients with high-grade mucinous peritoneal spread from appendiceal origin (some with “signet ring cell” features, some without)
Among them, 64 had received chemo before surgery (preSC) and 76 had not (noSC)
They compared groups on survival, disease recurrence, how completely the tumors could be removed, and other clinical factors.

What They Found

Median overall survival (time until death) was 40 months in the pre-chemo group vs 86 months in the no-chemo group.
Median progression-free survival (time until cancer returns or grows) was 19 months for pre-chemo vs 43 months for no-chemo.
In subgroup analyses (e.g. those with signet ring cell features, more aggressive histology), pre-chemo still did not show clear benefit.
Giving chemo beforehand did not lead to smaller tumor burden, easier tumor removal, or better surgical outcomes.

Why It Matters for Patients

For patients with high-grade appendix cancer, giving chemo before surgery + HIPEC may not provide added benefit.
This suggests that this kind of cancer might behave differently than other gastrointestinal cancers when it comes to chemo timing.
Treatment plans should be personalized: doctors and patients should carefully weigh whether neoadjuvant chemo is appropriate under specific circumstances.
More research is needed to identify which patients, if any, might benefit from chemo before surgery in the future.

Bottom Line

For people with high-grade appendix cancer that has spread in the abdomen, getting chemotherapy before surgery and heated chemotherapy (CRS + HIPEC) did not improve survival or delay the cancer from coming back.

Patients who went straight to surgery actually lived longer, on average, than those who had chemo first. The study suggests that pre-surgery chemotherapy doesn’t add benefit for most patients with this type of cancer — though treatment decisions should always be personalized.