Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Recurrent Peritoneal Carcinomatosis from Ovarian Cancer

Abstract

Aggressive surgical cytoreduction has been shown to have a positive impact on survival of patients with ovarian cancer. After first-line chemotherapy, 47% of patients relapse within 5 years, and median survival after second line chemotherapy is 10-15 months. Adding intraperitoneal chemohyperthermia (IPCH) to surgical cytoreduction could further control ceolomic spread of disease. The aim of this study was to determine morbidity and mortality, regional relapse-free survival and, preliminarily, overall survival after combining cytoreductive surgery with IPCH for the treatment of peritoneal carcinomatosis from ovarian epithelial cancer relapsed after prior chemotherapy. Thirty women affected with such a relapse were included. Patients underwent extensive cytoreductive surgery including tumor resections and peritonectomy, followed by intraoperative IPCH with cisplatin. Complete surgical cytoreduction down to nodules less than 2.5 mm (CC0-CC1) was obtained in 23 patients (77%). One patient died postoperatively from a pulmonary embolism. Major postoperative morbidity was 5/30 (16.7%). We registered one case of anastomotic leakage, a spontaneous ileum perforation, a postoperative cholecystitis, a hydrothorax, and one patient with bone marrow toxicity. Kaplan-Meier estimates of median locoregional relapse-free survival and median overall survival were 17.1 months and 28.1 months, respectively. Patients with CC0-CC1 had locoregional relapse-free and overall survival rates of 24.4 and 37.8 months, whereas the remainder had survival rates of 4.1 and 11.0 months. We concluded that cytoreductive surgery combined with IPCH is feasible with acceptable morbidity and mortality and seems to promise good results in selected patients affected with peritoneal carcinomatosis from ovarian cancer.

Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer

“…15,16 Although peritonectomy procedures with HIPEC found favor later in ovarian carcinomatosis than in other carcinomatoses, in recent years this therapeutic strategy has attracted growing interest. [17][18][19][20][21][22][23][24] The discrepant results from the various case series nevertheless leave several questions unclear, most important, the selection of patients according to the disease setting (primary or secondary cytoreduction) and extent of carcinomatosis, criteria for classifying intraperitoneal disease spread, and surgical techniques.…”

Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer

“…The completeness of cytoreduction, and the extent of peritoneal dissemination are consistently found to be significant prognostic indicators of survival Piso et al, 2004;Gilly et al, 2006;Di Giorgio et al, 2008;Tentes et al, 2010;Zanon et al, 2004;Rufian et al, 2006). Prior surgical score has been identified as a prognostic indicator of survival in one study (Look et al, 2004).…”

“…Prior surgical score has been identified as a prognostic indicator of survival in one study (Look et al, 2004). Median and 5-year survival rate varies from 18-54 months and 12-66% respectively (Piso et al, 2004;Raspagliesi et al, 2006;Di Giorgio et al, 2008;Tentes et al 2010, Ryu et al, 2004Zanon et al, 2004;Rufian et al, 2006;de Bree et al, 2003;Bae et al, 2007;Ceelen et al, 2009) ( Table 2). All these studies are prospective but not randomized (evidence level 4) and demonstrate that the method is feasible, well tolerated by the patients, and the results are equivalent or even improved if compared to historical data.…”

Therapeutic Strategies in Ovarian Cancer

“…Recurrent or persistent disease: the use of intraperitoneal CMT extended the period of progression of OC lesion from 10 to 21.8 months [Zanon, 2004;Helm, 2007]. -As first-line therapy: although logical, it is recommended an aggressive approach of OC, but when it was applied, the number of cases was too small for a conclusion [Piso, 2004].…”