Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases

Abstract

PurposeThe aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease.MethodsIn a retrospective Italian multicenter study investigating patients with advanced ovarian cancer who underwent CRS plus HIPEC between 1998 and 2014, we analyzed data for consecutive patients at eight treatment time points: primary debulking surgery (PDS); interval debulking surgery after partial response, after no response, and after a pathologic complete response to neoadjuvant chemotherapy; first recurrence with a progression-free interval >12, <12 months, or >12 months in patients who underwent further chemotherapy before CRS and HIPEC; and patients who underwent two or more CRS procedures and chemotherapy lines before CRS and HIPEC.ResultsThe 511 enrolled patients underwent 3373 procedures; 72.6% achieved complete cytoreduction, with an overall major morbidity of 17.4%. At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [CI] 44–58.4) and progression-free (PFS) survival was 16.6 months (95% CI 14.7–19.1). Outcome analysis in patients in whom CRS plus HIPEC was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and PFS according to the time points analyzed. Multivariate analysis identified completeness of CRS, Peritoneal Cancer Index, and the times when patients underwent CRS plus HIPEC as independent prognostic factors.ConclusionsThis selective information on survival should help in interpreting the findings from ongoing randomized studies focusing on CRS plus HIPEC in patients with advanced ovarian cancer.

Impact of extent of parietal peritonectomy on oncological outcome after cytoreductive surgery and HIPEC

“…TPP thus ensures to remove all diseased tissue and limits any marginal miss that can happen from cytoreduction in PSM. However, the benefits of TPP in patients undergoing HIPEC has been explored only in few studies [3,9,10] and it has been underutilized due to concerns of associated morbidity [10]. Retrospective analysis of peritonectomy procedures in patients undergoing HIPEC for mesothelioma by Baratti et al [9] showed that TPP group had better OS with similar morbidity rates and was recognized as an independent predictor of better prognosis at multivariate analysis.…”

“…It comprises of complete removal of macroscopic disease, so as to achieve a minimal residual disease of less than 2.5 mm 2 . Completeness of cytoreduction score (CC Score) has been found to be an important predictor of long term outcome after CRS in PSM of colorectal origin [2], ovary [3] and pseudomyxoma peritonei (PMP) [4].…”

Is HIPEC beneficial in platinum resistant relapsed ovarian cancer?

“…However, in a more recent study conducted by an Italian study group, conflicting results have been reported; contrarily to the French study, the Italian one came to demonstrate the efficacy of HIPEC exclusively in treating chemosensitive relapse from ovarian cancer; in the meantime, no clear benefit in terms of survival could be demonstrated for cases presenting resistant to platinum disease (16). Moreover, other studies excluded from the very beginning patients with platinum resistant disease from their study groups which aimed to investigate the effectiveness of HIPEC in recurrent ovarian cancer (17).…”

Neoadjuvant, adjuvant and long-term intravenous/intraperitoneal chemotherapy, hyperthermic intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy for ovarian cancer

“…At a median followup of 53.8 months overall survival was 54.2 months (95% CI 44-58.4) and PFS was 16.6 months (95%, CI 14.7-19.1). 65 …”