APPENDICEAL CARCINOMA - PATTERNS OF FAILURE FOLLOWING SURGERY AND IMPLICATIONS FOR ADJUVANT THERAPY

Background and Objectives: Primary adenocarcinoma of the appendix is r are, which makes an understanding of its natural history difficult. To date, it is treated predominantly with surgery alone. This review aim s to elucidate the patterns of failure and treatment outcomes when adj uvant treatment is given after primary surgical resection. Methods: Tw enty-three patients were treated with either surgery alone, or with su rgery and adjuvant radiation +/- chemotherapy. A review of the clinica l course of these patients was undertaken with an analysis of the loca l control, distant failure, disease-free survival, and overall surviva l. Results: Most patients presented with local invasion or metastatic disease often involving the peritoneum. Overall survival was 32%, simi lar to the results of other studies. Analysis of patients with locally advanced disease showed improvement in overall survival and local con trol with postoperative radiation therapy compared to surgery alone. C onclusions: Adenocarcinoma of the appendix is a rare disease that pres ents most often in an advanced stage. It has been shown by others that a right hemicolectomy pro,ides the best outcome with respect to surgi cal procedure. Postoperative irradiation appears to provide a benefit for both local control and overall survival. (C) 1997 Wiley-Liss, Inc.