Impact of Radicality Versus Timing of Surgery in Patients with Advanced Ovarian Cancer (Stage III C) Undergoing CRS and HIPEC—a Retrospective Study by INDEPSO

Abstract

HIPEC in addition to interval CRS has shown a survival benefit of 12 months compared to CRS alone. However, there are many controversial issues pertaining to CRS itself which should be addressed first. To compare NACT and primary CRS approaches when CRS is categorized according to the extent of resection. To evaluate the feasibility of performing HIPEC at these two time points. A retrospective analysis of patients with stage III C ovarian cancer undergoing primary and interval CRS + HIPEC was performed. The surgical approach for interval CRS was classified as (1) resection of sites of residual disease alone or (2) resection of sites involved before NACT. The morphological response was divided into different categories, and surgeons had to state what they consider residual disease and what they do not. From January 2013 to December 2017, 54 patients were included (18primary; 36-interval). Median PCI 11 vs 6.5 (p = 0.07); CC-0 was obtained in 77.7%. Three surgeons resected previously involved sites; three sites of residual disease only. All surgeons resected areas of scarring. Twenty percent patients had residual disease in Bnormal-looking^peritoneum. Morbidity (p = 0.09), median OS (p = 0.71), and median DFS (p = 0.54) were similar in the two groups. Early recurrence occurred in 50% with resection of residual disease alone compared to 16.6% when previous disease sites were resected (p = 0.07). Interval CRS should be performed to resect sites involved prior to NACT and not just sites of residual disease. HIPEC can be performed in both primary/interval settings with acceptable morbidity.

Upfront debulking surgery versus interval debulking surgery for advanced tubo‐ovarian high‐grade serous carcinoma and diffuse peritoneal metastases treated with peritonectomy procedures plus HIPEC

“…In this series of patients with diffuse peritoneal metastases at diagnosis from primary advanced tubo‐ovarian HGSC who underwent UDS or NACT‐IDS with peritonectomy procedures both followed by HIPEC in centers experienced in treating PSM, the two cytoreductive procedures, as Bhatt et al, reported led to similar outcomes.…”

“…After the study by Van Driel et al was published, despite criticisms, hyperthermic intraperitoneal chemotherapy (HIPEC) intended to complete cytoreductive surgical efforts began to gather interest also in the gynecological oncology community . Only one study published to date has investigated outcomes in a series that compares patients who underwent UDS versus NACT‐IDS treated with cytoreduction according to peritonectomy procedures both combined with HIPEC . Knowing whether this combined approach influences outcomes related to UDS or NACT IDS, including the site of recurrence, could help to improve therapeutic strategies in centers experienced in treating peritoneal surface malignancies (PSM).…”

“…25 Only one study published to date has investigated outcomes in a series that compares patients who underwent UDS versus NACT-IDS treated with cytoreduction according to peritonectomy procedures 26 both combined with HIPEC. 27 Knowing whether this combined approach influences outcomes related to UDS or NACT IDS, including the site of recurrence, could help to improve therapeutic strategies in centers experienced in treating peritoneal surface malignancies (PSM).…”

Distribution of residual disease in the peritoneum following neoadjuvant chemotherapy in advanced epithelial ovarian cancer and its potential therapeutic implications

“…It is possible that more extensive surgery following neoadjuvant chemotherapy can in part offset the poor prognostic impact of a poor response to systemic chemotherapy and this should be further evaluated. [22]…”

Distribution of residual disease in the peritoneum following neoadjuvant chemotherapy in advanced epithelial ovarian cancer and its potential therapeutic implications

“…It is possible that more extensive surgery following neoadjuvant chemotherapy can in part offset the poor prognostic impact of a poor response to systemic chemotherapy and this should be further evaluated. [22] Addressing regional nodes Though a recent randomized trial showed no benefit of systematic lymphadenectomy when nodes were not enlarged, this trial is only for surgery performed upfront and not for surgery following neoadjuvant chemotherapy. [23] Hence, in our opinion, there is no clear directive as to which patients should have regional lymphadenectomy following neoadjuvant chemotherapy.…”