Update on the management and the role of intraperitoneal chemotherapy for ovarian cancer

Abstract

The most important prognostic factor for ovarian cancer survival is the ability to achieve optimal cytoreduction with no residual disease. CRS and HIPEC should be considered as an option for the management of advanced ovarian cancer and further trials are required to determine its role in both the primary and recurrent settings.

Exploring the trend in referrals for consideration of CRS and HIPEC to understand the attitudes of clinicians in the development of a national cancer centre programme in peritoneal disease

“…Peritoneal metastases have traditionally been considered a harbinger of dismal prognosis with a fatal outcome. It occurs in up to 20% of patients first diagnosed with colorectal cancer, in more than 25% of those who recur [7,[10][11][12] and even more frequently in ovarian cancer [13]. Palliative treatment with systemic chemotherapy has traditionally been the standard of care for patients with peritoneal metastases but with such treatment, median survival remains poor at 6-12 months [5,14].…”

Are positron emission tomography-computed tomography (PET-CT) scans useful in preoperative assessment of patients with peritoneal disease before cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)?

“…CRS and HIPEC have been shown to improve survival for selected patients with PM and are increasingly being utilised in the treatment of patients with PM [1][2][3][4][5][6][7][8]. Achieving complete cytoreduction is paramount to the success of the procedure, making the pre-operative assessment of local and distant disease involvement one of the greatest challenges in selecting patients for CRS-HIPEC.…”

“…Patients with peritoneal disease were traditionally treated with a palliative intent, but since the 1990s, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been increasingly performed to treat PM, changing the management of PM entirely. In selected patients with appendiceal, colorectal, ovarian, primary peritoneal and peritoneal mesothelioma malignancies, this combined modality procedure has been shown to improve survival [1][2][3][4][5][6][7][8]. This dual-modality works on the principal that CRS removes all macroscopic disease and HIPEC targets the residual microscopic disease.…”

“…Pre-operatively, it is imperative to exclude extra-abdominal metastases and assess the ability to achieve optimum cytoreduction. Although there have been some studies demonstrating feasibility of concomitant liver or lung metastatectomy during CRS and HIPEC, the general consensus is that this aggressive modality should be reserved for those with peritoneal-only disease [1,4]. Additionally, a proportion of patients (25-48%) who are planned for CRS-HIPEC do not successfully complete the surgery, due to extensive disease noted intra-operatively.…”

Serum folate receptor α (sFR) in ovarian cancer diagnosis and surveillance

“…Although epithelial cancers display response rates of 80% to standard therapy, up to 70% of patients relapse within 2 years. This poor prognosis is due to lack of early detection, as well as to innate and acquired resistance to chemotherapy . Specifically, while early‐stage OVCA is often cured by surgery, <30% of OVCAs are detected in stage 1, with >60% diagnosed at Stage 3/4.…”