Critical Analysis of Stage IV Epithelial Ovarian Cancer Patients after Treatment with Neoadjuvant Chemotherapy followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC)

Abstract

Background. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients. Methods. Advanced EOC from 2015–2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed. Perioperative factors were assessed. Overall survival (OS) and progression-free survival (PFS) were analyzed by stage. Results. Twenty-seven FIGO stage IIIC (n = 12) and IV (n = 15) patients were reviewed. Median NACT cycles were 3 and 4, respectively. Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV. SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively. Median organ resections were 6 and 7, respectively. Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality. Median time to adjuvant chemotherapy was 53 and 74 days, respectively ( p = 0.007 ). SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV ( p = 0.269 ). SIII 1-year PFS was 54%; median PFS: 12 months. SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months ( p = 0.944 ). Conclusion. Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.

Combined Interval Cytoreductive Surgery and Carboplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Advanced Primary High-Grade Serous Ovarian Cancer

“…The relatively short follow-up period and inclusion of patients with stage IV disease may also have affected the DFS and OS rates. Some studies have shown similar results for stage IV patients following interval CRS with HIPEC [28,29]. Although statistical significance was not observed consistently, results for stage IV patients show a tendency for shorter DFS and OS.…”

Value of an 18F-FDG-based peritoneal cancer index in predicting tumor grade, tumor burden, and completeness of cytoreductive surgery in epithelial ovarian cancer

“…A study to investigate whether there is a cutoff that might suggest resectability would be useful and may then be of help in determining operability. The surgical PCI cutoff level for predicting completeness of CRS is controversial now, with reported cutoff values ranging from 15-25 [27,42,43]. Even so, this discovery bought a survival bene t to selecting CRS candidates and effectively avoided unnecessary aggressive surgery.…”