The low mortality rate and 12.5 % grade III-IV morbidity of CRS and HIPEC are acceptable when weighed against overall oncologic survival. This multimodal treatment appears feasible for selected patients and trained centers.

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5542 Background: Optimal treatment of chemoresistant and recurrent ovarian cancer is debating with second line chemotherapies. For peritoneal carcinomatosis new treatment combining cytoreductive surgery with heated intraperitoneal per operative chemotherapy (HIPEC) may improve survival. Methods: Retrospective bicentric study of 246 patients with peritoneal carcinomatosis from ovarian cancer were performed to evaluate HIPEC and to identify prognostic factors. Peritoneal Cancer Index (PCI) assess tumor load and completeness cytoreductive score (CCS) was used to give quality of resection CC0 (no visible tumor), CC1 (persistent diffuse lesions < 2.5mm), CC2 (2.5mm < CC2 < 25mm) and over CC3 status. HIPEC is performed with platinum based regimen at 42°C. Endpoint was survival. Kaplan-Meier survival curve was fitted to the data. Cox's regression model was used for multivariate survival analysis. Results: The study included 268 procedures in 246 patients from 1991 to 2008. 206 procedures were performed in 184 patients with recurrence (Group 1) and 62 in chemoresistant patients (Group 2). After completion of resection the allocation of CCS was CC0 = 164, CC1 = 83, CC2 = 15, and CC3 = 5. Only 1 patient died in post operative course and procedure related morbidity rate was 12%. 5 years overall and free survival were respectively 35 % and 10%. Median overall survival was 49 months and the median disease free survival was 13 months. There was no difference between group 1 and 2 for survival. Independent prognostic factors for survival were the carcinomatosis extent, the completeness of cytoreductive surgery (HR = 2.26 IC95 [1.3–3.91]), performance status (HR = 4.3 IC95 [1.23–14.4]) and redo procedure (HR = 0.9 IC95 [0.001–0.9]). Conclusions: Hipec is a standardized and reproducible feasible method. Less extensive disease and the quality of cytoreduction remain an independent factor of better outcome. Morbidity is acceptable. To date in selected patients, HIPEC allows to reach the longest median time survival in recurrent peritoneal carcinomatosis from ovarian cancer. No significant financial relationships to disclose.

We report a case of grade III pseudomyxoma peritonei revealed by mucusuria and abdominal mass. These symptoms are unusual; the most frequent clinical presentation is acute appendicitis or progressively increasing abdominal diameter.

e15574 Background: Evaluate FDG-PET/CT utility for the detection of peritoneal carcinomatosis from ovarian cancer treated by chemotherapy by using surgical and histopathological findings as the standard of reference. Methods: 38 patients (46 to 68 years) with recurrent (n=35) or primary (n=3) ovarian cancer were reviewed for the presence of peritoneal lesions on FDG-PET/CT before cytoreductive surgery and HIPEC treatment. 30 had adenocarcinomas (13 papillary serous, 7 moderately differenciated, 6 poorly differentiated, 3 serous and 1 serous cystadenocarcinoma) and 2 endometrioid tumors. 9 had psammomatous calcifications. All were suspected cases of PC. 35 patients had received adjuvant chemotherapy and 3 neoadjuvant chemotherapy (primary cancer). FDG-PET/CT results were reinterpreted by two experienced nuclear medicine physicians who knew that PC was suspected. The FDG uptake was determined as SUVmax in the most active lesion in all abdomino-pelvic quadrants (average SUVmax= 6.1; range 1.1- 25). SUVmax in the liver was also measured (average SUVmax=2.9). All PET/CT exams were realised on the same machine. Results: FDG PET/CT diagnosed 18 in 32 patients with peritoneal metastases. There was no suspicious site of abnormal FGD uptake in the supradiaphragmatic regions. The sensitivity, specificity and accuracy of FDG PET/CT were respectively 59,100, 66%. The positive and negative predictive value of FDG PET/CT were 100 and 31%. 13 false negative PET/CT findings were due to millimetric or infracentimetric perihepatic, mesenteric and omental implants (unseen on PET/CT) and to nodules less than one centimeter with no significant FDG uptake (SUVmax lower than hepatic uptake). The true negative findings were found after chemotherapy. Conclusions: FDG-PET/CT can be considered as a useful tool for the selection of patients for HIPEC treatment in the absence of distant metastasis. It showed excellent results for the positive diagnosis and tumor burden for lesions more than 1 cm (PPV 100%). The sensitivity was low in the presence of millimetric disease with or without prior chemotherapy before HIPEC.

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5075 Background: Optimal treatment of peritoneal recurrences in ovarian cancer is debating with second line chemotherapies. We proposed association of secondary surgery with heated intraperitoneal per operative chemotherapy (HIPEC). The aim of study is to determine prognostic factors in a single center cohort. Methods: Retrospective study of consecutive 169 patients with peritoneal recurrence from ovarian cancer were performed to evaluate HIPEC and to identify prognostic factors. Peritoneal Cancer Index (PCI) assess tumor load and completeness cytoreductive score (CCS) were used to give quality of resection CCS0 (no visible tumor), CCS1 (persistent diffuse lesions < 2.5mm), CCS2 (2.5mm <CC2< 25mm) and over CCS3 status. HIPEC is performed with platinum based regimen. Endpoint was survival. Cox's regression model was used for multivariate survival analysis and extending Cox model for modelling survival data. Results: We have operated on 197 procedures (HIPEC) in 169 patients from 2000 to 2011. Mean age was 58 years old range [28-75]. Median PCI was 10. After completion of resection, allocation of CCS was CCS0=120, CCS1=70, CCS2 & CCS3 =7. Procedure related mortality was 1% and morbidity 21%, mean length of hospital stay was 17 days range [7-51]. 3 and 5 years overall survival were respectively 64.7% and 37.4 %. Median survival was 47.6 months and the median disease free survival was 20 months. PCI >10 (even if complete resection performed) and CCS2&3 were worse prognostic factors (HR respectively = 2.64 IC 95% [1.29-5.36] and = 3.31 IC 95 % [1.55-7.08]). Modelling of these factors, is very strong to predict risk of death over the 2 first years after HIPEC. Conclusions: The chemo-hyperthermia is a standardized and reproducible feasible method. Less extensive disease and the quality of cytoreduction remain an independent factor of better outcome. To date HIPEC allows to reach the longest median time survival in peritoneal recurrent ovarian cancer. Modelling survival data is useful to know the risk of dying.