Hyperthermic intraperitoneal chemotherapy in interval debulking surgery for advanced epithelial ovarian cancer: A single‐center, real‐life experience

Abstract

BACKGROUND: An improvement in survival without increasing perioperative morbidity in patients with advanced epithelial ovarian cancer treated with hyperthermic intraperitoneal chemotherapy (HIPEC) after interval debulking surgery (IDS) has been recently demonstrated in a randomized controlled trial. This study was aimed at assessing the feasibility and perioperative outcomes of the use of HIPEC after IDS at a referral cancer center. METHODS: Over the study period, 149 IDSs were performed. Patients who had at least International Federation of Gynecology and Obstetrics stage III disease, with <2.5 mm of residual disease (RD) at the end of surgery and were not participating in clinical trials received HIPEC. Moreover, specific exclusion criteria were considered. These patients were compared with 51 patients with similar clinical characteristics at the same institution and within the same timeframe who did not receive HIPEC. RESULTS: No differences in patient or disease characteristics with the exception of the type of neoadjuvant chemotherapy (P = .002) were found between the 2 groups. As for surgical characteristics, significant differences were found in RD after IDS (P = .007) and in the duration of surgery (P < .001), whereas the bowel resection and diversion rates (P = .583 and P = .213, respectively) and the postoperative intensive care unit and hospital stays (P = .567 and P = .727, respectively) were comparable. The times to start adjuvant chemotherapy were also similar (P = .998). Equally, the rates of any grade of both intraoperative complications (P = .189) and early postoperative complications (P = .238) were superimposable. CONCLUSIONS: In the authors' experience, the addition of HIPEC to IDS is feasible in 35% for the population. This value might increase with changes in the inclusion/exclusion criteria. HIPEC does not increase perioperative complications and does not affect a patient's recovery or time to start adjuvant chemotherapy. HIPEC should be offered to select patients listed for IDS. Cancer 2020;0:5256-5262.

Role of surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer

“…According to an Italian singlecentre, prospectively collected cohort study, 34.9% (52/ 149) of patients with EOC who received interval CRS underwent HIPEC throughout 2019. 57 In this study, HIPEC was administered to not only patients with FIGO stage IIIC disease, but also those with stage IV disease (34.6%), which differed from the study by van Driel et al 6 All patients in the HIPEC group received i.p. perfusion with 100 mg/m 2 cisplatin via the closed technique at 41 C for 90 min.…”

“…Neither patient recovery nor the time of adjuvant chemotherapy initiation was affected by HIPEC. 57 According to a Korean single-centre, protocol-based study, 61.5% (40/65) of patients with FIGO stage IIIC-IV EOC underwent paclitaxel and carboplatin combination NACT and interval CRS. 58 After the interval CRS, HIPEC was administered to patients who achieved optimal cytoreduction (residual disease 1.0 cm) unless (i) complete remission was achieved after NACT, (ii) excessive bleeding occurred during surgery, or (iii) patient refused to undergo the procedure.…”

Can We Decrease Epicardial and Pericardial Fat in Patients With Diabetes?

“…The concept of “debulking” we propose originates from cancer treatment where it has potential benefits. 181…”

The addition of sodium thiosulphate to hyperthermic intraperitoneal chemotherapy with cisplatin in ovarian cancer

“…There is still paucity of evidence to support the use of sodium thiosulphate in HIPEC outside of the OVIHIPEC-1 trial. A number of historical cohort studies have demonstrated that ST may protect against nephrotoxicity following cisplatin-based HIPEC at a dose of at least 100 mg/m 2 ( Ceresoli et al, 2016 Jun , Bakrin et al, 2014 , Markman et al, 1985 , Ceelen et al, 2012 Jul , Jones et al, 2006 , Ghirardi et al, 2020 Dec 15 ). Zanon et al used cisplatin at both 100 and 150 mg/m 2 for 60 min and renal injury was noted in two patients who did not receive ST ( Zanon et al, 2004 ).…”

“…Zanon et al used cisplatin at both 100 and 150 mg/m 2 for 60 min and renal injury was noted in two patients who did not receive ST ( Zanon et al, 2004 ). Ghirardi et al recently reported on the real-life experience of the implementation of HIPEC using the OVIHIPEC-1 protocol, however did not focus on renal morbidity ( Ghirardi et al, 2020 ). Based on this background, the purpose of this study was to analyse the implementation of HIPEC for EOC within a tertiary peritoneal malignancy centre and the impact of the addition of sodium thiosulphate infusion on renal toxicity.…”