Evaluation of Extensive Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients With Advanced Epithelial Ovarian Cancer

• DOI: 10.1097/igc.0b013e31824d836c
• Publication Date: 2012-05-09T08:17:24Z
• Authors: Luca Ansaloni; Vanni Agnoletti; Andrea Amadori; Fausto Catena; Davide Cavaliere; Federico Coccolini; Pierandrea Delaco; Monica Di Battista; Massimo Framarini; Filippo Gazzotti; Claudio Ghermandi; Barbara Kopf; Maristella Saponara; Francesca Tauceri; Carlo Vallicelli; Giorgio Maria Ver...; Antonio Daniele P...
• Keywords: Intraperitoneal chemotherapy; 0302 clinical medicine; Antineoplastic Combined Chemotherapy Protocols; Cytoreductive surgery; Mucinou; Ovarian Neoplasms; 600; Middle Aged; Adenocarcinoma, Mucinous; Combined Modality Therapy; 3. Good health; Survival Rate; Local; Female; Peritoneal Neoplasm; Injections, Intraperitoneal; Human; Adult; Paclitaxel; Prognosi; Cystadenocarcinoma; 610; Cytoreductive surgery; Intraperitoneal chemotherapy; Ovarian cancer; Peritoneal carcinomatosis; Adenocarcinoma, Mucinous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Cystadenocarcinoma, Serous; Doxorubicin; Endometrial Neoplasms; Feasibility Studies; Female; Follow-Up Studies; Humans; Injections, Intraperitoneal; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Paclitaxel; Peritoneal Neoplasms; Prognosis; Prospective Studies; Survival Rate; Hyperthermia, Induced; Adenocarcinoma; Follow-Up Studie; Injections; 03 medical and health sciences; Serou; Ovarian cancer; Humans; Endometrial Neoplasm; Intraperitoneal; Hyperthermia; Aged; Neoplasm Staging; Antineoplastic Combined Chemotherapy Protocol; HIPEC; ovarian cancer; Ovarian Neoplasm; Induced; Hyperthermia, Induced; Cystadenocarcinoma, Serous; Endometrial Neoplasms; Peritoneal carcinomatosi; Feasibility Studie; Prospective Studie; Neoplasm Recurrence; Doxorubicin; Feasibility Studies; Cisplatin; Neoplasm Recurrence, Local; Follow-Up Studies

Although standard treatment for advanced epithelial ovarian cancer (EOC) consists of surgical debulking and intravenous platinum- and taxane-based chemotherapy, favorable oncological outcomes have been recently reported with the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to analyze feasibility and results of CRS and HIPEC in patients with advanced EOC.This is an open, prospective phase 2 study including patients with primary or recurrent peritoneal carcinomatosis due to EOC. Thirty-nine patients with a mean (SD) age of 57.3 (9.7) years (range, 34-74 years) were included between September 2005 and December 2009. Thirty patients (77%) had recurrent EOC and 9 (23%) had primary EOC.For HIPEC, cisplatin and paclitaxel were used for 11 patients (28%), cisplatin and doxorubicin for 26 patients (66%), paclitaxel and doxorubicin for 1 patient (3%), and doxorubicin alone for 1 patient (3%). The median intra-abdominal outflow temperature was 41.5°C. The mean peritoneal cancer index (PCI) was 11.1 (range, 1-28); and according to the intraoperative tumor extent, the tumor volume was classified as low (PCI <15) or high (PCI ≥15) in 27 patients (69%) and 12 patients (31%), respectively. Microscopically complete cytoreduction was achieved for 35 patients (90%), macroscopic cytoreduction was achieved for 3 patients (7%), and a gross tumor debulking was performed for 1 patient (3%). Mean hospital stay was 23.8 days. Postoperative complications occurred in 7 patients (18%), and reoperations in 3 patients (8%). There was one postoperative death. Recurrence was seen in 23 patients (59%) with a mean recurrence time of 14.4 months (range, 1-49 months).Hyperthermic intraperitoneal chemotherapy after extensive CRS for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in highly selected patients. Additional follow-up and further studies are needed to determine the effects of HIPEC on survival.