Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2019; 11(9): 116-125
Published online Sep 28, 2019. doi: 10.4329/wjr.v11.i9.116
Metastatic appendiceal cancer treated with Yttrium 90 radioembolization and systemic chemotherapy: A case report
Ambarish P Bhat, Philip A Schuchardt, Roopa Bhat, Ryan M Davis, Sindhu Singh
Ambarish P Bhat, Philip A Schuchardt, Roopa Bhat, Ryan M Davis, Department of Vascular and Interventional Radiology, University of Missouri Columbia, Columbia, MO 65212, United States
Sindhu Singh, Department of Medicine, Section of Hematology-Oncology, University of Missouri-Columbia, Columbia, MO 65212, United States
Author contributions: Bhat AP planned and performed the Y90 radioembolization, wrote the paper, and responded to edits from both the University of Missouri care team and publication editors. Schuchardt PA wrote the paper and participated in the editing process. Bhat R wrote the paper and participated in the editing process. Davis RM planned and performed the Y90 radioembolization and participated in the editing process. Singh S prescribed the patient’s chemotherapy and provided advice regarding recommended treatments.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: No conflict of interest declared.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ambarish P Bhat, MD, Assistant Professor, Department of Vascular and Interventional Radiology, University of Missouri Columbia, One Hospital Drive, Columbia, MO 65212, United States. bhatap@health.missouri.edu
Telephone: +1-573-8821025 Fax: +1-573-8844457
Received: March 2, 2019
Peer-review started: March 4, 2019
First decision: August 2, 2019
Revised: August 10, 2019
Accepted: August 21, 2019
Article in press: Auguet 21, 2019
Published online: September 28, 2019
Abstract
BACKGROUND

Primary appendiceal cancers are rare, and they generally present with liver and/or peritoneal metastases. Currently there are no guidelines to treat metastatic appendiceal cancer, and hence they are treated as metastatic colorectal cancer. Combining Yttrium 90 (Y-90) radioembolization (RE) with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival. Based on this data, a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.

CASE SUMMARY

A 76-year-old male presented to the emergency room with progressive right lower quadrant pain. A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation. Urgent laparoscopic appendectomy was then followed by histological analysis, which was significant for appendiceal adenocarcinoma. After complete workup he underwent right hemicolectomy and lymph node dissection. He received adjuvant chemotherapy as the local lymph nodes were positive. Follow-up imaging was significant for liver metastasis. Due to rapid growth of the liver lesions and new peritoneal nodules, the patient was treated with a combination of Y-90 RE and folinic acid, fluorouracil, and irinotecan with bevacizumab and not microwave ablation as previously planned. Follow up imaging demonstrated complete response of the liver lesions. At 12-mo follow-up, the patient continued to enjoy good quality of life with no recurrent disease.

CONCLUSION

Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.

Keywords: Colorectal cancer, Liver metastases, Radioembolization, Yttrium 90 microspheres, Appendix cancer with peritoneal metastasis, Hyperthermic intraperitoneal chemotherapy, Case report

Core tip: Primary appendiceal cancers are rare and there are no current guidelines for treatment of metastatic appendiceal cancer. We describe an unusual case of appendiceal cancer metastatic to the liver and peritoneum that was successfully treated with a combination of systemic chemotherapy and Yttrium 90 radioembolization. This complete and sustained response may support a role for combination therapy in the more aggressive right sided colon cancers.