Critical Analysis of Stage IV Epithelial Ovarian Cancer Patients after Treatment with Neoadjuvant Chemotherapy followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC).

Carlos A Munoz-Zuluaga,Carol Nieroda,Vadim Gushchin,Armando Sardi,Michelle Sittig,Mary C King,Teresa P Diaz-Montes,Felipe Lopez-Ramirez,C H Yip

doi:10.1155/2020/1467403

Abstract

Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients. Methods Advanced EOC from 2015–2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed. Perioperative factors were assessed. Overall survival (OS) and progression-free survival (PFS) were analyzed by stage. Results Twenty-seven FIGO stage IIIC (n = 12) and IV (n = 15) patients were reviewed. Median NACT cycles were 3 and 4, respectively. Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV. SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively. Median organ resections were 6 and 7, respectively. Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality. Median time to adjuvant chemotherapy was 53 and 74 days, respectively (p=0.007). SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV (p=0.269). SIII 1-year PFS was 54%; median PFS: 12 months. SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months (p=0.944). Conclusion Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.

Highlights

Epithelial ovarian, fallopian tube, and primary peritoneal cancers, known as epithelial ovarian cancer (EOC), are heterogeneous diseases staged and treated [1, 2].ese diseases account for the majority of deaths from gynecological cancers in developed countries, due to scarcity of symptoms at early stages and lack of screening methods [3]
Primary debulking surgery (PDS) followed by postoperative or adjuvant systemic chemotherapy (ASC) with taxane-platinum combinations is standard for advanced EOC (AEOC) [4]
An institutional cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) database was reviewed, identifying newly diagnosed AEOC patients who received neoadjuvant chemotherapy (NACT) followed by CRS/HIPEC from 2015–2018. is treatment approach was offered at our institution to AEOC patients deemed ineligible for the randomized clinical trial (NCT 02124421) which assesses the role of CRS/HIPEC as initial treatment in AEOC

Summary

Introduction

Epithelial ovarian, fallopian tube, and primary peritoneal cancers, known as epithelial ovarian cancer (EOC), are heterogeneous diseases staged and treated [1, 2].ese diseases account for the majority of deaths from gynecological cancers in developed countries, due to scarcity of symptoms at early stages and lack of screening methods [3]. NACT plus interval cytoreductive surgery (CRS) without HIPEC demonstrated improved perioperative outcomes but nonsuperiority in terms of time to recurrence and survivals compared to PDS [5, 11, 12]. We assessed our experience treating newly diagnosed stage IV (SIV) EOC with NACT plus interval CRS/HIPEC and compared findings to the same treatment cohort of stage IIIC (SIII) patients. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); stage IV (SIV) outcomes are rarely reported. We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients. Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC. SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach

Methods

Results

Discussion

Conclusion