Interval debulking surgery with or without hyperthermic intraperitoneal chemotherapy in advanced-stage ovarian cancer: Single-institution cohort study

Abstract

To evaluate the additive effects of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval debulking surgery (IDS) in patients with advanced-stage ovarian cancer. From January 2015 to February 2019, 123 patients with stages IIIC-IV ovarian cancer were treated with neoadjuvant chemotherapy (NAC) followed by IDS with optimal cytoreduction. Forty-three patients received IDS with HIPEC and 80 patients had IDS without HIPEC. The median follow-up period was 34.4 months. No differences in baseline characteristics in patients were found between the two groups. The IDS with HIPEC group had fewer median cycles of chemotherapy (P = 0.002) than the IDS group. The IDS with HIPEC group had a higher rate of high surgical complexity score (P = 0.032) and higher rate of complete resection (P = 0.041) compared to the IDS group. The times to start adjuvant chemotherapy were longer in the IDS with HIPEC group compared to the IDS group (P < 0.001). Postoperative grade 3 or 4 complications were similar in the two groups (P = 0.237). Kaplan-Meier analysis showed that HIPEC with the IDS group had better progression-free survival (PFS) (P = 0.010), while there was no difference in overall survival between the two groups (P = 0.142). In the multivariate analysis, HIPEC was significantly associated with better PFS (HR, 0.60; 95% CI, 0.39 - 0.93). The addition of HIPEC to IDS resulted in longer PFS than IDS without HIPEC not affecting the safety profile. Further research is needed to evaluate the true place of HIPEC in the era of targeted treatments.

Hyperthermic Intraperitoneal Chemotherapy After Interval Cytoreductive Surgery for Patients With Advanced-Stage Ovarian Cancer Who Had Received Neoadjuvant Chemotherapy

“…The HIPEC procedure lasted 90 minutes, the perfusion solution was completely drained, and bowel anastomosis was performed if needed. To prevent nephrotoxicity in patients who underwent HIPEC with cisplatin, sodium thiosulfate was administered intravenously at a bolus dose of 9 g/m 2 in 200 mL at the start of HIPEC perfusion, followed by continuous infusion (12 g/m 2 in 1000 mL) over 6 hours during and after HIPEC . Patients received additional POAC after surgery.…”

“…To prevent nephrotoxicity in patients who underwent HIPEC with cisplatin, sodium thiosulfate was administered intravenously at a bolus dose of 9 g/m 2 in 200 mL at the start of HIPEC perfusion, followed by continuous infusion (12 g/m 2 in 1000 mL) over 6 hours during and after HIPEC. 14 Patients received additional POAC after surgery. During follow-up, serum cancer antigen 125 (CA-125) measurements and computed tomography were performed 1 month after surgery and every 3 months for 1 year and every 6 months thereafter until 5 years after chemotherapy completion.…”

Peritoneal metastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)

“…HIPEC can target residual microscopic disease left behind after CRS, improving the quality of CRS and assisting in the delivery of high-dose chemotherapy directly to the peritoneum. These benefits are evidenced by a significantly lower incidence of peritoneal recurrences in patients with ovarian cancer treated with CRS/HIPEC compared to those treated with CRS alone [ 29 ], [ 30 ], [ 31 ], suggesting that adding HIPEC to interval CRS improves intraperitoneal disease control in HGS ovarian cancer [ 32 ]. In our study, less than 50 % of patients had disease recurrence after CRS/HIPEC, with higher rates of extra-vs. intra-peritoneal recurrences (50.0 vs. 25.0 %).…”