Does hyperthermic intraoperative chemotherapy lead to improved outcomes in patients with ovarian cancer? A single center cohort study in 111 consecutive patients

Abstract

BackgroundFor recurrent disease or primary therapy of advanced ovarian cancer, cytoreductive surgery (CRS) followed by adjuvant chemotherapy is a therapeutic option. The aim of this study was to evaluate the outcome for patients with epithelial ovarian cancer treated with hyperthermic intraoperative chemotherapy (HIPEC) and completeness of cytoreduction (CC).MethodsData were retrospectively collected from 111 patients with recurrent or primary ovarian cancer operated with the contribution of visceral surgical oncologists between 1991 and 2006 in a tertiary referral hospital.ResultsNinety patients received CRS and 21 patients CRS plus HIPEC with cisplatin. Patients with complete cytoreduction (CC0) were more likely to receive HIPEC. Overall, 19 of 21 patients (90.5 %) with HIPEC and 33 of 90 patients (36.7 %) with CRS had a complete cytoreduction (P < 0.001). Incomplete cytoreduction was associated with worse survival rates with a hazard ratio (HR) of 4.4 (95%CI: 2.3-8.4) for CC1/2 and 6.0 (95%CI: 2.9-12.3) for CC3 (P < 0.001). In a Cox-regression limited to 52 patients with CC0 a systemic concomitant chemotherapy (HR 0.3, 95%CI: 0.1-0.96, P = 0.046) but not HIPEC (HR 0.98 with 95 % CI 0.32 to 2.97, P = 0.967) improved survival. Two patients (9.5 %) developed severe renal failure after HIPEC with absolute cisplatin dosages of 90 and 95 mg.ConclusionsCompleteness of cytoreduction was proved to be crucial for long-term outcome. HIPEC procedures in ovarian cancer should be performed in clinical trials to compare CRS, HIPEC and systemic chemotherapy against CRS with systemic chemotherapy. Concerning the safety of HIPEC with cisplatin, the risk of persistent renal failure must be considered when dosage is based on body surface.

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

“…They found that CRS alone had a similar rate of major morbidity compared to HIPEC+CRS (26.7% vs 28.6%, respectively), however, CRS alone had a substantially higher 30-day post-operative mortality rate (11.1% vs 0%, respectively) [28]. The causes of death in this study were cardiac or pulmonary insufficiency in four patients, sepsis in three patients, multi-organ failure in two patients, and pulmonary embolism in one patient.…”

“…Selection bias likely accounts for these results, whereby patients with primary advanced ovarian cancers who improved following chemotherapy with taxol or carboplatin were given HIPEC, whilst those that did not respond did not receive HIPEC. days [24], 14±4 vs 10±4 days [30], 32.9 vs 27.5 days [28]). The likelihood of being admitted into ICU was also higher with the addition of HIPEC (100 vs 72.2% [28]).…”

“…days [24], 14±4 vs 10±4 days [30], 32.9 vs 27.5 days [28]). The likelihood of being admitted into ICU was also higher with the addition of HIPEC (100 vs 72.2% [28]). One study found a longer LOS for CC0-1 vs CC2-3 (17 vs 12 days) [55].…”

“…In the comparative studies, only one [28] of the eight studies reported complications separately for CRS with and without HIPEC. They found that CRS alone had a similar rate of major morbidity compared to HIPEC+CRS (26.7% vs 28.6%, respectively), however, CRS alone had a substantially higher 30-day post-operative mortality rate (11.1% vs 0%, respectively) [28].…”

“…Four studies used HIPEC after CRS and adjuvant chemotherapy [24][25][26][27], and four studies performed HIPEC with CRS, followed by adjuvant chemotherapy [15,[28][29][30].…”