Treatment of peritoneal metastases from small bowel adenocarcinoma

Figures & data

Table 1. Percentage of patients with PM from SBA.

	mSBA	PM	PM
Study	N	n	%
Legué et al. [7]	581	168	29
Debaja et al. [8]	75	19	25
Locher et al. [10]	16	6	38
Fishman et al. [11]	64	31	48
Overman et al. [12]	80	37	46
Overman et al. [13]	25	9	36
Zaanan et al. [14]	80	40	50
Zaanan et al. [15]	27	12	44
Koo et al. [16]	87	42	48
Tshushima et al. [17]	122	37	30
Xiang et al. [18]	29	9	31
Total	1186	410	35

mSBA: metastatic small bowel adenocarcinoma; PM: peritoneal metastases.

Table 2. Studies that investigate ORR, DCR, PFS, OS, or grade III–V toxicity (NCICTC) in patients who receive first line systemic therapy for advanced SBA.

Author		Systemic therapy		ORR	DCR	X^2	Median PFS		Median OS		III–V toxicity
Year (inclusion)	n	Regimen	%	%	%	p	Months	Log rank	Months	Log rank	%	X^2 p
(a) Phase II studies that investigate predefined outcome parameters
Gibson et al. [21] 2005 (1983–1985)	38	5-FU + mitomycin C + doxorubicin	100	19	31	–	5	–	8	–	68	–
Overman et al. [13] 2009 (2004–2007)	30	CAPOX	100	50	90	–	11	–	20	–	–	–
Xiang et al. [18] 2012 (2007–2011)	33	FOLFOX	100	49	85	–	8	–	15	–	39	–
(b) Non-comparative observational studies that investigate predefined outcome parameters
Crawley et al. [19] 1998 (1990–1995)	8	Yes 5-FU 5-FU + cisplatin	100 38 62	37	75	–	8	–	13	–	25	–
Fishman et al.[11] 2006 (1986–2004)	44	Yes Various regimens	100	30	50	–	–	–	11	–	–	–
Ono et al. [23] 2008 (1999–2007)	8	Yes Irinotecan + cisplatin	100 100	13	75	–	5	–	17	–	–	–
Suenaga et al. [24] 2009 (2001–2006)	10	Yes 5-FU	100 100	11	56	–	3	–	12	–	10	–
Zhang et al. [26] 2011 (2004–2010)	34	Yes FOLFOX CAPOX	100 82 18	32	62	–	6	–	14	–	–	–
(c) Comparative observational studies that compare predefined outcome parameters between different systemic therapy regimens
Locher et al. [10] 2005 (1992–2000)	20	Yes 5-FU + cisplatin 5-FU + carboplatin FOLFOX	100 75 10 15	21 20 0 33	79	–	8	–	14	–	45 53 0 33	–
Overman et al. [12] 2008 (1978–2005)	80	Yes 5-FU + platinum 5-FU or other	100 36 64	25 46 16	–	0.01	5 9 4	<0.01	13 15 12	0.10	–	–
Zaanan et al. [14] 2010 (1996–2008)	93	Yes 5-FU 5-FU + cisplatin FOLFIRI FOLFOX	100 11 17 20 52	26 0 31 9 34	74 50 69 73 79	0.18	7 8 5 6 7	0.16  0.02^a	15 14 9 11 18	0.25  0.04^a	33 0 75 39 46	<0.01^c
Tsushima et al. [17] 2012 (1999–2009)	132	Yes 5-FU 5-FU + cisplatin FOLFIRI FOLFOX Other	100 45 13 8 17 17	– 20 38 25 42 21	–	–	– 5 4 6 8 3	0.03^b	– 14 13 9 22 8	0.16^b	–	–
(d) Comparative observational studies that compare survival outcomes between systemic therapy vs. no systemic therapy
Debaja et al. [8] 2004 (1978–1998)	71	Yes No	68 32	–	–	–	–	–	12 2	0.02	–	–
Czaykowski et al. [22] 2007 (1990–2000)	37	Yes 5-FU based No	43 100 57	6	–	–	–	–	16 8	–	–	–
Moon et al. [25] 2009 (1986–2007)	87	Yes 5-FU 5-FU + cisplatin Gemcitabine based Other No	39 56 32 6 6 61	28	59	–	4	–	9 4	0.01	–	–
Halfdanarson et al. [9] 2010 (1970–2005)	165	Yes No	– –	–	–	–	–	–	16 3	<0.01	–	–
Koo et al. [16] 2011 (1989–2009)	91	Yes 5-FU 5-FU + platinum 5-FU + irinotecan No	44 30 63 8 56	11	37	–	6 1	<0.01	12 4	<0.01	–	–
Khan et al. [27] 2015 (1996–2011)	59	Yes Triplet Doublet Other No	78 50 39 11 22	50	67	–	–	–	61%^d 27%^d	0.04	–	–

5-FU: 5-fluorouracil; CAPOX: capecitabine, oxaliplatin; DCR: disease control rate; FOLFOX: 5-fluorouracil, leucovorin, oxaliplatin; FOLFIRI: 5-fluorouracil, irinotecan; ORR: objective response rate; OS: overall survival; PFS: progression-free survival, X²: chi-square test.

^a FOLFOX vs. 5-FU with cisplatin.

^b FOLFOX vs. 5-FU monotherapy.

^c 5-FU and cisplatin vs. other regimens.

^d One-year overall survival.

Table 3. Observational studies that investigate DFS, OS, and grade III–V morbidity in patients who undergo cytoreductive surgery with intraperitoneal chemotherapy for peritoneal metastases arising from SBA.

Author		IPC technique		Median DFS	Median OS^a	Median OS^b	III–V morbidity
Year (inclusion)	n	CRS with	%	Months	Months	Months	%
Marchettini et al. [37] 2002 (–)	6	HIPEC + EPIC	100	–	16	–	–
Chua et al. [39] 2009 (1997–2009)	7	HIPEC + EPIC EPIC HIPEC	57  29  14	12	25	–	29
Elias et al. [40] 2010 (1989–2007)	31	HIPEC EPIC	68  32	–	47	–	35
Sun et al. [41] 2013 (1995–2011)	17	HIPEC	100	–	18	37	12
Van Oudheusden et al. [42] 2015 (2005–2014)	16	HIPEC	100	10	31	–	25
Liu et al. [43] 2015 (2006–2014)	31	HIPEC	100	–	36	51	26

CRS: cytoreductive surgery; DFS: disease-free survival; EPIC: early postoperative intraperitoneal chemotherapy; HIPEC: hyperthermic intraperitoneal chemotherapy; OS: overall survival; SBA: small bowel adenocarcinoma.

^a Measured from CRS + IPC.

^b Measured from diagnosis with PM from SBA.

Legué LM, Bernards N, Gerritse SL, et al. (2016). Trends in incidence, treatment and survival of small bowel adenocarcinomas between 1999 and 2013: a population-based study in the Netherlands. Acta Oncol 55:1183–9.

 PubMed Web of Science ®Google Scholar

Debaja BS, Suki D, Pro B, et al. (2004). Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer 101:518–26.

 PubMed Web of Science ®Google Scholar

Locher C, Malka D, Boige V, et al. (2005). Combination chemotherapy in advanced small bowel adenocarcinoma. Oncology 69:290–4.

 PubMed Web of Science ®Google Scholar

Fishman PN, Pond GR, Moore MJ, et al. (2006). Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases. Am J Clin Oncol 29:225–31.

 PubMed Web of Science ®Google Scholar

Overman MJ, Kopetz S, Wen S, et al. (2008). Chemotherapy with 5-fluorouracil and a platinum compound improves outcomes in metastatic small bowel adenocarcinoma. Cancer 113:2038–45.

 PubMed Web of Science ®Google Scholar

Overman MJ, Varadhachary GR, Kopetz S, et al. (2009). Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol 27:2598–603.

 PubMed Web of Science ®Google Scholar

Zaanan A, Costes L, Gauthier M, et al. (2010). Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study. Ann Oncol 21:1786–93.

 PubMed Web of Science ®Google Scholar

Zaanan A, Gauthier M, Malka D, et al. (2011). Second-line chemotherapy with fluorouracil, leucovorin, and irinotecan (FOLFIRI regimen) in patients with advanced small bowel adenocarcinoma after failure of first-line platinum-based chemotherapy: a multicenter AGEO study. Cancer 117:1422–8.

 PubMed Web of Science ®Google Scholar

Koo DH, Yun SC, Hong YS, et al. (2011). Systemic chemotherapy for treatment of advanced small bowel adenocarcinoma with prognostic factor analysis: retrospective study. BMC Cancer 11:205.

 PubMed Web of Science ®Google Scholar

Tsushima T, Taguri M, Honma Y, et al. (2012). Multicenter retrospective study of 132 patients with unresectable small bowel adenocarcinoma treated with chemotherapy. Oncologist 17:1163–70.

 PubMed Web of Science ®Google Scholar

Xiang XJ, Liu YW, Zhang L, et al. (2012). A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs 23:561–6.

 PubMed Web of Science ®Google Scholar

Gibson MK, Holcroft CA, Kvols LK, Haller D. (2005). Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma. Oncologist 10:132–7.

 PubMed Web of Science ®Google Scholar

Crawley C, Ross P, Norman A, et al. (1998). The Royal Marsden experience of a small bowel adenocarcinoma treated with protracted venous infusion 5-fluorouracil. Br J Cancer 78:508–10.

 PubMed Web of Science ®Google Scholar

Ono M, Shirao K, Takashima A, et al. (2009). Combination chemotherapy with cisplatin and irinotecan in patients with adenocarcinoma of the small intestine. Gastric Cancer 11:201–5.

 Web of Science ®Google Scholar

Suenaga M, Mizunuma N, Chin K, et al. (2009). Chemotherapy for small-bowel adenocarcinoma at a single institution. Surg Today 39:27–31.

 PubMed Web of Science ®Google Scholar

Zhang L, Wang LY, Deng YM, et al. (2011). Efficacy of the FOLFOX/CAPOX regimen for advanced small bowel adenocarcinoma: a three-center study from China. J Buon 16:689–96.

 PubMed Web of Science ®Google Scholar

Czaykowski P, Hui D. (2007). Chemotherapy in small bowel adenocarcinoma: 10-year experience of the British Columba Cancer Agency. Clin Oncol (R Coll Radiol) 19:143–9.

 PubMed Web of Science ®Google Scholar

Moon YW, Rha SY, Shin SJ, (2010). Adenocarcinoma of the small bowel at a single Korean institute: management and prognosticators. J Cancer Res Clin Oncol 136:387–94.

 PubMed Web of Science ®Google Scholar

Halfdanarson TR, McWilliams RR, Donohue JH, Quevedo JF. (2010). A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg 199:797–803.

 PubMed Web of Science ®Google Scholar

Khan K, Peckitt C, Sclafani F, et al. (2015). Prognostic factors and treatment outcomes in patients with Small Bowel Adenocarcinoma (SBA): the Royal Marsden Hospital (RMH) experience. BMC Cancer 15:15.

 PubMed Web of Science ®Google Scholar

Marchettini P, Sugarbaker PH. (2002). Mucinous adenocarcinoma of the small bowel with peritoneal seeding. Eur J Surg Oncol 28:19–23.

 PubMed Web of Science ®Google Scholar

Chua TC, Koh JL, Yan TD, et al. (2009). Cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma. J Surg Oncol 100:139–43.

 PubMed Web of Science ®Google Scholar

Elias D, Glehen O, Pocard M, et al. (2010). A comparative study of complete cytoreductive surgery plus intraperitoneal chemotherapy to treat peritoneal dissemination from colon, rectum, small bowel, and nonpseudomyxoma appendix. Ann Surg 251:896–901.

 PubMed Web of Science ®Google Scholar

Sun Y, Shen P, Stewart JH, et al. (2013). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from small bowel adenocarcinoma. Am Surg 79:644–8.

 PubMed Web of Science ®Google Scholar

van Oudheusden TR, Lemmens VE, Braam HJ, et al. (2015). Peritoneal metastases from small bowel cancer: results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the Netherlands Surgery 157:1023–7.

 Google Scholar

Liu Y, Ishibashi H, Takeshita K, et al. (2016). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal dissemination from small bowel malignancy: results from a single specialized center. Ann Surg Oncol 23:1625–31.

 PubMed Web of Science ®Google Scholar