The Investigators are researching how to improve the treatment currently available for patients diagnosed with Pseudomyxoma Peritonei (PMP). This is a rare cancer that usually starts in the appendix and spreads around the abdomen.
PMP is usually treated using a type of surgery called Cytoreductive Surgery (CRS). During the surgery heated chemotherapy will also be used to treat any cancer cells that cannot be seen and may be left behind. This is called Hyperthermic Intraperitoneal Chemotherapy (HIPEC).
This treatment is commonly used in the UK and in Europe, however, the chemotherapy can be given at two different doses: a lower dose over 60 minutes or a higher-dose over 90 minutes.
The Investigators want to understand if there is a difference between these two doses. The higher dose has been associated with a slightly increased rate of complications but may be better at killing cancer cells and preventing recurrence of cancer. In Basingstoke the lower dose over 60 minutes is used and survival results are similar to centres who use the higher dose.
Previous studies have shown that both doses are effective at treating PMP, but no research has shown which is better for patients. The Investigators hope to show that the lower-dose over 60-minutes is as good as the higher-dose over 90-minutes.
Clinical and/or radiological diagnosis of pseudomyxoma peritonei from a primary mucinous epithelial tumours of the appendix (low and high grade)
The extent of intraperitoneal disease must be deemed to be amenable to complete cytoreduction (CC0-1, i.e. residual disease of < 2.5mm in diameter).
Patients aged 16 or more and capable of giving informed consent for the procedures and interventions of the current trial.
ECOG performance status 0-1.
Patients who have previously undergone cytoreductive surgery and/or intraperitoneal chemotherapy.
Clinical evidence or suspicion of metastases to sites different than peritoneum or intra-abdominal lymph nodes
Hypersensitivity to the active substance (mitomycin) or its excipients (mannitol, hydrochloric acid, sodium hydroxide)
Patients with conditions which may affect their ability to understand, retain and weigh up the information related to the requirements and consenting process of the study
Parallel
Mitomycin c
DrugMitomycin is a tumour antibiotic isolated from the broth of Streptomyces species. It has alkylating properties, which results in DNA cross-linking. Once MMC enters the tumour cell, it needs microsomal modification by various enzymes to be transformed into active state; free radicals constituted of semiquinones of MMC are responsible for its cytotoxic effects. Mitomycin is licenced in the UK and recommended by NICE for intraperitoneal chemotherapy.
Disease Free Survival
To compare disease free survival between low- and high-dose mitomycin C (MMC).
Adverse Events using Common Terminology Criteria for Adverse Events
To compare short- and long-term toxicity between arms.
EQ-5D-5L Quality of Life Questionnaire
To compare short- and long-term quality of life between arms.
QLQ-C30 Quality of Life Questionnaire
To compare short- and long-term quality of life between arms.
MODRUM Healthcare Resource Use Questionnaire
To compare the cost-effectiveness of high dose with low dose mitomycin. Participants will document how often they have used healthcare services over a period of 2 years following surgery. The number of uses of healthcare services reported by participants will be compared between the two arms.
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