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

Authors


Dr M Deraco, Peritoneal Surface Malignancy Programme, Department of Surgery, Istituto Nazionale Tumori Milano Via Venezian n.1, 20133 Milano, Italy. Email marcello.deraco@istitutotumori.mi.it

Abstract

Please cite this paper as: Deraco M, Virzì S, Raspagliesi F, Iusco D, Puccio F, Macrì A, Famulari C, Solazzo M, Bonomi S, Grassi A, Baratti D, Kusamura S. Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi-institutional study. BJOG 2012;119:800–809.

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.

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