Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction

Jay Chouhan, Rohan Gupta, Joe Edward Ensor, Jr., Kanwal Raghav, David Fogelman, Robert A Wolff, Michael Fisch, Michael J Overman

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Malignant small bowel obstruction (MSBO) that does not resolve with conservative measures frequently leaves few treatment options other than palliative care. This single-institution retrospective study assesses the outcomes of a more aggressive approach-concurrent systemic chemotherapy and total parenteral nutrition (TPN)-in the treatment of MSBO. The MD Anderson pharmacy database was queried to identify patients who received concurrent systemic chemotherapy and TPN between 2005 and 2013. Only patients with MSBO secondary to peritoneal carcinomatosis requiring TPN for ≥8 days were included. Survival and multivariate analyses were performed using the Kaplan-Meier method and Cox proportional hazard models. The study included 82 patients. MSBO resolution was observed in 10 patients. Radiographic assessments showed a response to chemotherapy in 19 patients; 6 of these patients experienced MSBO resolution. Patients spent an average of 38% of their remaining lives hospitalized, and 28% of patients required admission to the intensive care unit. In multivariate modeling, radiographic response to chemotherapy correlated with MSBO resolution (odds ratio [OR] 6.81; 95% confidence interval [CI], 1.68-27.85, P = 0.007). Median overall survival (OS) was 3.1 months, and the 1-year OS rate was 12.6%. Radiographic response to chemotherapy (HR 0.30; 95% CI, 0.16-0.56, P < 0.001), and initiation of new chemotherapy during TPN (HR 0.55; 95% CI, 0.33-0.94, P = 0.026) independently predicted for longer OS. Concurrent treatment with systemic chemotherapy and TPN for persistent MSBO results in low efficacy and a high morbidity and mortality, and thus should not represent a standard approach.

Original languageEnglish (US)
Pages (from-to)239-47
Number of pages9
JournalCancer Cell
Volume5
Issue number2
DOIs
StatePublished - Feb 2016

Keywords

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols
  • Female
  • Humans
  • Intestinal Obstruction
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasms
  • Odds Ratio
  • Parenteral Nutrition, Total
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult
  • Journal Article

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