Intraperitoneal 5-fluorouracil for pseudomyxoma peritoneii

Pseudomyxoma peritoneii has an indolent course but a 5-year survival rate of 40-45%. The role for postoperative intraperitoneal chemotherapy is unclear. Nine patients with pseudomyxoma arising from mucinous neoplasms of the ovary and intestinal tract received a total of 89 courses of intraperitoneal 5-fluorouracil (IP5FU). Each course consisted of eight 4-h exchanges of 1 g of 5FU in 2 l of 1.5% Inpersol(R). Median follow-up after diagnosis was 30 months (range 6-74). All patients were evaluable for toxicity and response. There was one treatment-related death due to renal failure and sepsis. Three patients developed disease progression prior to scheduled second-look laparotomy. At second-look laparotomy two patients demonstrated pathologic complete responses, one had stable disease and one had progression of disease. One patient remained clinically free of progression after refusing second-look laparotomy. The projected 5-year survival by Kaplan-Meier estimate was 87% for patients treated with IP5FU compared to a 52% 5-year survival seen in a series of 11 patients treated prior to the use of IP5FU (P = 0.12). This preliminary analysis suggests that IPFU in the described schedule fails to improve survival statistically compared to previously used regimens for patients with pseudomyxoma peritoneii.