Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from ovarian cancer: A multiinstitutional study of 246 patients

Abstract

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.

Role of hyperthermic intraperitoneal chemotherapy in ovarian cancer

“…Nevertheless it is to be noted that the reason why HIPEC has not been established as a standard of care in ovarian cancer is a attributable to the discrepancies between published data, with non-comparable patient groups, unclear first-line treatments with or without NACT, not stating if the patients were sensitive to platinum agents or non-responders, furthermore the available results of OS and DFS lack information about timing, meaning if patients are on their first or second recurrence, which continues to be a drawback in this field of research. For the retrospective data (28,34,37,38,(72)(73)(74)(75)(76)(77)(78)(79)(80), for prospective data (27,35,36,40,44,45,48,81,82) (Tables 1,2).…”

Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

“…Multiple nonrandomized single and multicenter phase II and few phase III trials indicate that CRS and HIPEC may improve survival rate for selected patients with peritoneal metastasis[ 2 , 6 - 8 ]. There has been an observed increase in survival rates with CRS and HIPEC in colorectal cancer, advanced ovarian cancer, gastric cancer and peritoneal mesothelioma[ 9 - 14 ]. This procedure is technically challenging and has the potential for increased morbidity and mortality[ 15 ].…”