Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer

Abstract

BackgroundMore information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsThis study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome.ResultsA total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2 for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor.ConclusionsFor selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma.

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) vs CRS alone for treatment of endometrial cancer with peritoneal metastases: a multi-institutional study from PSOGI and BIG RENAPE groups

“…Few series with a small number of patients have been reported of CRS with HIPEC for treatment of EC with promising outcomes and well-tolerated procedures [ 4 , 13 – 17 ].…”

Assessing Tumor Size by MRI and Pathology in Type I Endometrial Carcinoma to Predict Lymph Node Metastasis

“…Uterine risk factors include tumor histology, tumor size, lymphovascular invasion, cervical stroma invasion, and invasion depth. Extrauterine risk factors include peritoneal cytology, nodal involvement (pelvic and paraaortic), intraperitoneal metastasis, and ovarian metastasis [9][10][11][12]. However, volume index, serum CA-125 levels, myometrial invasion, and grade are the most significant risk factors for lymph node metastasis [13].…”

ASO Author Reflections: Peritoneal Metastases from Endometrial Cancer

“…Despite being retrospective, our study, contributes previously unavailable, detailed evidence-based information on the treatment of peritoneal metastases from EC with CRS plus HIPEC. Especially when CRS leaves no residual disease, this combined treatment, given in experienced centers to properly selected cases, achieves outcome rates approaching those for the most frequent indications (colorectal, ovarian cancer) 4…”