Surgical resection and intraperitoneal chemotherapy for recurrent abdominal sarcomas

Background: Recurrent abdominal sarcomas have an extremely high rate of rec urrence and poor overall survival. A prospective study was initiated to ass ess the feasibility, toxicity, and benefit of surgical resection and intrap eritoneal chemotherapy for improving local control of disease and overall s urvival. Methods: Fifty-four patients underwent surgical excision of all gross disea se and postoperative intraperitoneal chemotherapy with mitoxantrone. Thirty -five patients had peritoneal disease only (stage II), and 19 patients had peritoneal disease with hepatic metastases (stage III). Results: Nine (17%) patients remain free of disease with a mean follow-up o f 37 months. The remaining 45 patients (83%) have had recurrence, with a me an interval to recurrence of 11 months. Stage (P = .001) and grade (P = .00 5) were the only two variables found to significantly affect recurrence. Th ere was an overall peritoneal recurrence rate of 48% and an overall hepatic failure rate of 69%. Nineteen (35%) of the patients are alive, with a mean follow-up of 46 months. The overall 5-year survival was 31%. The 5-year su rvival for stage II patients was 46%; for stage III patients, it was only 5 %. Stage (P = .001) and grade (P = .056) were the only two variables found to significantly affect survival. There were no treatment-related deaths, a nd only 5 patients (9%) developed local complications. Conclusions: Aggressive surgical resection and intraperitoneal chemotherapy for recurrent abdominal sarcomas is a feasible treatment approach with min imal toxicity. Although this treatment had little effect on the hepatic spr ead of this disease and thus overall survival, it appears to have significa ntly lowered the rate of peritoneal recurrence and may provide a survival b enefit for patients with disease limited to the peritoneum.