Outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal dissemination from ovarian carcinosarcoma

Lopez-Ramirez, Felipe; Sardi, Armando; Studeman, Kimberley; King, Mary Caitlin; Zuñiga, Luis Felipe Falla; Nikiforchin, Andrei; Baron, Ekaterina; Nieroda, Carol; Gushchin, Vadim; Díaz-Montes, Teresa

doi:10.1016/j.ejso.2023.03.230

Cited by 3 publications

(2 citation statements)

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“…Tumors were defined as rare if recording an incidence of less than six cases per 100,000 annually [ 3 ], and included non-high grade serous (HGS) tumors, sex-cord, and germ cell tumors. Carcinosarcomas, complex and rare tumors that involve both cellular components of epithelium and mesenchyme, were excluded from this study and its outcomes were analyzed separately [ 15 , 16 ]. Patients who had an aborted HIPEC were excluded from the post-HIPEC morbidity/mortality analysis.…”

Section: Methodsmentioning

confidence: 99%

Peritoneal metastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)

Falla-Zuniga,

Sardi,

King

et al. 2023

Pleura and Peritoneum

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Objective There are limited treatment options and no consensus on the management of advanced rare ovarian malignancies. Rare ovarian malignancies can present with peritoneal metastases (PM), featuring a similar presentation to more common ovarian subtypes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for PM of non-gynecologic origin and, recently, epithelial ovarian cancer. We evaluated the feasibility of CRS/HIPEC in the management of PM from rare ovarian malignancies and report postoperative outcomes on these patients. Methods A retrospective review of a single center, prospective database (1994–2021) was performed to identify patients with rare ovarian malignancies treated with CRS/HIPEC. Clavien-Dindo 90-day morbidity/mortality and Kaplan–Meier overall (OS) and progression-free survival (PFS) were analyzed. Results Of 44 patients identified, 28 underwent CRS/HIPEC. Six were aborted due to extensive disease. Histologic subtypes included: clear cell (5/28, 17.9 %), endometrioid (5/28, 17.9 %), granulosa cell (3/28, 10.7 %), low-grade serous (6/28, 21.4 %), mesonephric (1/28, 3.6 %), mucinous (6/28, 21.4 %), and small cell (2/28, 7.1 %) carcinomas. Eight (28.6 %) patients had primary and 20 (71.4 %) had recurrent disease. Median peritoneal cancer index (PCI) was 21 (IQR: 6–29). Complete cytoreduction (<2.5 mm residual disease) was achieved in 27/28 (96.4 %). Grade III/IV complications occurred in 9/28 (32.1 %) with one (3.6 %) mortality. After a median follow-up of 65.8 months, 20 patients were alive. Five-year OS and PFS were 68.5 and 52.6 %, respectively. Conclusions In patients with PM from rare ovarian malignancies, CRS/HIPEC is feasible and has an acceptable safety profile. Longer follow-up and multicenter trials are needed.

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Section: Methodsmentioning

confidence: 99%

Peritoneal metastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)

Falla-Zuniga,

Sardi,

King

et al. 2023

Pleura and Peritoneum

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“…Optimal cytoreductive surgery followed by chemotherapy has been frequently considered in the primary management of the disease, despite no available RCTs [ 53 ]. A retrospective study reviewed a cohort of patients ( n = 267) from 1999 to 2021 who were diagnosed with peritoneal dissemination from tubo-ovarian malignancies and had undergone cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) [ 54 ]. Sixteen out of the 267 patients had confirmed OCS with advanced disease (FIGO stage III or above) and received adjuvant chemotherapy with either cisplatin, a combination of cisplatin and doxorubicin, or melphalan.…”

Section: Introductionmentioning

confidence: 99%

Frontiers of Ovarian Carcinosarcoma

Ismail,

Choi,

Boussios

2023

Curr. Treat. Options in Oncol.

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Opinion statementOvarian carcinosarcoma (OCS), also known as a malignant mixed Müllerian tumour (MMMT), is a rare and aggressive form of cancer that accounts for less than 5% of ovarian cancers. It is characterized by high morbidity and mortality rates, with a median overall survival (OS) of less than 2 years. Several factors, including advancing age, nulliparity, reduced lactation rates, decreased use of oral contraceptive pills, genetic mutations in BRCA (breast cancer) genes, and the use of assisted reproductive technology, may increase the risk of OCS. Poor prognostic factors include an advanced stage at diagnosis, older age, lymph node metastasis, suboptimal surgical cytoreduction, the presence of heterologous features on histopathology, and increased expression of vascular endothelial growth factor (VEGF), tumour protein p53, and p53 alongside Wilms tumour 1 (WT1). The main treatment approach for OCS is cytoreductive surgery followed by platinum-based chemotherapy, although immunotherapy is showing promise. Homologous recombination deficiency (HRD) testing may enhance outcomes by enabling personalized immunotherapy and targeted therapies for specific patient groups, thereby reducing unnecessary side effects and healthcare costs. However, there is currently a lack of standardised treatment regimens for OCS patients, with most studies consisting of case reports and a shortage of suitable comparator groups. This article aims to provide clinicians with information on the epidemiology, risk factors, prognostic factors, and latest therapeutic advancements in OCS.

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Collaborative expertise of gynecological and surgical oncologists in managing advanced epithelial ovarian cancer

Nikiforchin,

Sardi,

King

et al. 2024

European Journal of Surgical Oncology

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Outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal dissemination from ovarian carcinosarcoma

Cited by 3 publications

References 30 publications

Peritoneal metastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)

Peritoneal metastases from rare ovarian cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC)

Frontiers of Ovarian Carcinosarcoma

Collaborative expertise of gynecological and surgical oncologists in managing advanced epithelial ovarian cancer

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