<p>Feasibility and safety of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy in patients with advanced stage ovarian cancer: a single-center experience</p>

Abstract

For patients with advanced ovarian cancer, neoadjuvant chemotherapy (NACT) can significantly increase the rate of optimal cytoreduction. However, this does not translate into a survival benefit. The aim of this study was to investigate the feasibility and effect of neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (NLHIPEC). Methods: Between March 2016 and February 2018, 14 patients with advanced ovarian cancer who were not candidates for optimal cytoreduction via primary debulking surgery (PDS) received NLHIPEC. Their clinical data were retrospectively analyzed. Results: No patients experienced intraoperative complications during NLHIPEC. Grade 3 adverse events (AEs) were noted in two (14.3%) patients, and all patients received planned NACT without dose delay or dose reduction. Following NACT, CA125 levels <35 U/mL and <20 U/mL were observed in six (42.9%) patients and five (35.7%) patients, respectively. All patients underwent interval debulking surgery (IDS) after the last NACT cycle. After IDS, R0 resection was achieved in 10 (71.4%) patients without intraoperative injury, and one (7.1%) patient developed a grade 3 AE. During a median follow-up time of 16 months, no patients died of disease, and the median progression-free survival (PFS) was not achieved. Progression was noted in six (42.9%) patients (range, 9-21 months). Conclusions: NLHIPEC appears to be a feasible option for ovarian cancer patients who have a low likelihood of achieving optimal cytoreduction during PDS.

Assessing feasibility and perioperative outcomes with minimally invasive surgery compared with laparotomy for interval debulking surgery with hyperthermic intraperitoneal chemotherapy for advanced epithelial ovarian cancer

“…In addition, MIS cytoreductive surgery combined with HIPEC was associated with reduced interval to chemotherapy [ 22 ]. In addition, similar to our results, in a retrospective study of 14 patients with EOC who underwent MIS HIPEC following NACT, no post-operative complications occurred and the majority of patients (71.4%) had R0 resection [ 23 ]. Our data builds on these prior studies supporting that in women with advanced EOC, HIPEC at the time of MIS IDS is feasible and with low rates of post-operative complications.…”

Neoadjuvant Laparoscopic HIPEC combined with Neoadjuvant Chemotherapy followed by Surgery plus intraoperative HIPEC for Advanced Gastric Cancer at risk of Peritoneal Carcinomatosis: feasibility and safety assessment from retrospective case control study

“…The aim of this study was to investigate the feasibility of a more comprehensive and relatively aggressive treatment regimen in the management of locally advanced GC. The efficacy of HIPEC as a prophylaxis against PC primary to disease progression or secondary to surgical trauma has been investigated and supported in previous literature [14,[19][20][21][22] . The role of chemotherapy in the pre-surgical setting with the main goals of tumor downsizing and down-staging has also been thoroughly investigated and acclaimed over the past few decades [27][28][29][30] .…”

“…In a study by Coccolini et al, prophylactic HIPEC associated to NAC increased the DFS and OS in patients with AGC without carcinomatosis [19] . Nevertheless, there have been more reports about the combination of NAC followed by HIPEC improving the survival rates in ovarian cancer [20][21] . On the other hand, there have been fewer reports about the efficacy of laparoscopic HIPEC (L-HIPEC): in a report by Yonemura et al, L-HIPEC combined with intraperitoneal chemotherapy could decrease PCI index before cytoreductive procedures [22] .…”

Calculating the dose of cisplatin that is actually utilized in hyperthermic intraperitoneal chemotherapy among ovarian cancer patients

“…This recommendation is based on the evidence that the synergistic effect of hyperthermia and cisplatin can be dramatically increased at 42°C [10]. Data from clinical research also confirmed the safety and effectiveness of HIPEC at 43°C [31][32][33][34]. In general, the properties of biological tissues, the toxicity of drugs and their mutual influences change under hyperthermic conditions; some of the changes are temperature dependent [35].…”