Minimally Invasive Secondary Cytoreduction Plus HIPEC Versus Open Surgery Plus HIPEC in Isolated Relapse From Ovarian Cancer: A Retrospective Cohort Study on Perioperative Outcomes

Fagotti, Anna; Costantini, Barbara; Gallotta, Valerio; Cianci, Stefano; Ronsini, Carlo; Petrillo, Marco; Pacciani, Mara; Scambia, Giovanni; Fanfani, Francesco

doi:10.1016/j.jmig.2014.11.008

Cited by 56 publications

(46 citation statements)

References 23 publications

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“…Our data are in line with the interim analysis of a recently published phase II trial showing no deaths or grade 4 morbidities in a population of 30 AOC patients receiving extensive cytoreductive plus HIPEC [24]. Moreover, we confirmed a very favorable prognosis (3-years PFS=60.5%) [345678910], with a PFS>PFI-1 in more than 50% of patients [4], and a superimposable clinical outcome when comparing open, and minimally invasive surgical route [1415].…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, the continuous effort to achieve the highest locoregional control with the lowest toxicity profile has resulted in the successful administration of cisplatin-based HIPEC after minimally invasive cytoreductive surgery in women with AOC [1415]. Besides the advantages of minimally-invasive surgery itself, this approach appears an intriguing pharmacological strategy, given the evidences in pig models of an increased cisplatin diffusion using the endoscopic route compared with the traditional open approach [1617].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study

et al. 2019

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Objective Evidences from animal models seem to suggest that minimally invasive surgery may enhance cisplatin diffusion when the drug is administered in the context of post-operative hyperthermic intraperitoneal chemotherapy (HIPEC). The present study evaluates the cisplatin pharmacokinetic profile in a prospective series of women with platinum sensitive recurrent epithelial ovarian cancer treated with open secondary cytoreductive surgery (O-SCS) or minimally-invasive secondary cytoreductive surgery (MI-SCS). Methods Cisplatin levels were assessed at 0, 20, 40, 60, and 120 minutes in: 1) blood samples, 2) peritoneal perfusate, and 3) peritoneal biopsies at the end of HIPEC. Median C max has been used to identify women with high and low drug levels. Progression-free survival (PFS) was calculated as the time elapsed between SCS+HIPEC and secondary recurrence or last follow-up visit. Results Nine (45.0%) women received MI-SCS, and 11 (55.0%) O-SCS. At 60 minutes, median cisplatin C max in peritoneal tissue was higher in patients treated with MI-SCS compared to O-SCS (C max =8.262 µg/mL vs. C max =4.057 µg/mL). Furthermore, median cisplatin plasma C max was higher in patients treated with MI-SCS compared to O-SCS (C max =0.511 vs. C max =0.254 µg/mL; p-value=0.012) at 120 minutes. With a median follow-up time of 24 months, women with higher cisplatin peritoneal C max showed a longer PFS compared to women with low cisplatin peritoneal levels (2-years PFS=70% vs. 35%; p-value=0.054). Conclusions We demonstrate for the first time that minimally invasive route enhances cisplatin peritoneal tissue uptake during HIPEC, further evaluations are needed to confirm the correlation between peritoneal cisplatin levels after HIPEC and survival. Trial Registration ClinicalTrials.gov Identifier: NCT01539785

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study

et al. 2019

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“…Robotic-assisted cytoreductive surgery for peritoneal disease has already been successfully used in metastatic ovarian cancers. 95 In addition, with the advent of telesurgery, HIPEC can be introduced to areas that lack trained surgical oncologists.…”

Section: Future Directionsmentioning

confidence: 99%

Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

Rajeev

Turaga

2016

Cancer Control

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“…In this context, some experiences have shown that a comprehensive treatment approach of surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) could be able to improve the prognosis of AEOC as reported in few clinical studies [8][9][10][11][12][13][14][15][16][17]. Despite the established rationale and these encouraging results, a certain degree of skepticism still surrounds HIPEC in AEOC, involving inherent potential morbidity and the paucity of randomized data confirming its theoretical advantage.…”

Section: Introductionmentioning

confidence: 99%

Upfront HIPEC and bevacizumab-containing adjuvant chemotherapy in advanced epithelial ovarian cancer

Paris

Cianci

Vizzielli

et al. 2018

International Journal of Hyperthermia

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Introduction: In advanced epithelial ovarian cancer patients, the standard of care is primary debulking surgery, followed by first-line chemotherapy often with bevacizumab addiction. In this context, some experiences have shown that a comprehensive treatment approach to surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) could improve the prognosis. Objective: This is a study aimed to explore the feasibility of primary debulking surgery and HIPEC upfront followed by first-line therapy with bevacizumab. Study Design: Phase II monocentric, open label, non-randomised and single-arm study. Forty patients affected by advanced ovarian cancer submitted to primary debulking surgery with HIPEC were enrolled in the study. After surgery, all patients underwent systemic chemotherapy with bevacizumab addiction. Results: Complete cytoreduction (RT ¼ 0) was achieved in all cases. Treatment-related early complications were observed in 23 patients and in 15 cases were G1-G2. Major complications were reported in 8 patients. No postoperative death was recorded. Subsequent chemotherapy was administered in all cases. Median time between surgery and first cycle of chemotherapy was 42 days (range 30-76). Concomitant bevacizumab was administered in 34 patients (85%). Maintenance with bevacizumab was feasible in 33 patients (82.5%) and its withdrawal was necessary for 1 patient (2.5%) due to G3 hypertension. Conclusion: Our data suggest that HIPEC can be safely introduced in the upfront therapy of advanced ovarian cancer.

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Minimally Invasive Secondary Cytoreduction Plus HIPEC Versus Open Surgery Plus HIPEC in Isolated Relapse From Ovarian Cancer: A Retrospective Cohort Study on Perioperative Outcomes

Cited by 56 publications

References 23 publications

Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study

Pharmacokinetics of cisplatin during open and minimally-invasive secondary cytoreductive surgery plus HIPEC in women with platinum-sensitive recurrent ovarian cancer: a prospective study

Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in the Management of Peritoneal Carcinomatosis

Upfront HIPEC and bevacizumab-containing adjuvant chemotherapy in advanced epithelial ovarian cancer

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