Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi‐institutional study

Abstract

Objective To assess the efficacy and morbidity and mortality of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer (EOC).Design A retrospective study conducted using information extracted from a multi-institutional prospective database on peritoneal surface malignancies (PSMs). Setting Four Italian centres specializing in locoregional treatment of PSM.Population Patients with recurrent EOC.Methods Fifty-six patients underwent 57 combined procedures. CRS was performed using peritonectomy procedures and HIPEC using the closed-abdomen technique with cisplatin and doxorubicin or cisplatin and mitomycin-C.Main outcome measures Overall survival (OS), progression-free survival (PFS), morbidity and mortality rates.Results The median age of the patients was 55.2 years (range 30-75 years). The median peritoneal cancer index was 15.2 (range 4-30). Forty-seven patients had microscopic residual disease (completeness of cytoreduction, CC-0), seven had residual disease £2.5 mm (CC-1) and one had residual disease >2.5 mm (CC>2). Major complications occurred in 15 patients (26.3%), and procedure-related mortality occurred in three patients (5.3%). The median follow-up time was 23.1 months. The median OS and PFS were 25.7 (95% CI 20.3-31.0) and 10.8 (95% CI 5.4-16.2) months, respectively. The 5-year OS and PFS were 23% and 7%, respectively. Independent prognostic factors affecting OS according to the multivariate analysis were Eastern Cooperative Oncology Group performance status, preoperative serum albumin, and completeness of cytoreduction.Conclusions Patients with recurrent EOC treated with CRS and HIPEC showed promising results in terms of outcome. The combined treatment strategy could benefit subsets of patients wider than that defined for conventional secondary debulking surgery without HIPEC. These data warrant further evaluation in randomised clinical trials.

Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis

“…The study identified a significantly higher 2-and 5-year OS rate in those with HIPEC+CRS+chemotherapy Interestingly, two large studies in this review did not find a statistically significant difference in overall survival between platinum-sensitive and platinum-resistant patients treated with HIPEC+CRS [37,68]. This is an unexpected finding as patients with platinumresistant recurrent EOC often have a far worse prognosis compared to those with platinumsensitive disease when treated with systemic chemotherapy.…”

“…Similarly, another large study found platinum-resistant interval did not influence the median overall survival or DFS [37]. The OS curves of the two groups (sensitive and resistant) revealed very similar, superimposable patterns in the first 2 years.…”

“…Thereafter, the platinum-resistant group showed an abrupt reduction in the cumulative rate of the probability of OS, whereas in the platinum-sensitive group this stabilised at 28% until the end of study period [37].…”

“…The HIPEC chemotherapy used, temperature and duration was described in all 37 studies (eTable 2). The most commonly used HIPEC chemotherapy was cisplatin (CDDP) that was used either alone [26,42,49,50,55], or in combination with other agents such as doxorubicin [36,37,41,45,56], paclitaxel [40] or mitomycin-C [34,57] Figure 1). Only one study reached median overall survival for CRS with and without HIPEC (64.4 months and 46.4, respectively).…”

Heated IntraPEritoneal Chemotherapy (HIPEC) for Patients With Recurrent Ovarian Cancer: A Systematic Literature Review

“…In the largest multicenter study, 76 with N = 474 patients, cisplatin was the most commonly used agent (75%) either on its own or in combination with mitomycin or doxorubicin. Five studies 77Y81 used cisplatin with doxorubicin, 77,79,80 paclitaxel, 78 or mitomycin. 79Y81 Three studies used oxaliplatin, 56,72,73 with only 1 study electing to use it in combination (with irinotecan in some patients).…”