Current approaches to the treatment of advanced ovarian cancer using PET / CT-guided hyperthermic chemoperfusion. A clinical experience

Abstract

Background. Ovarian malignancies constitute the 8th most common cancer in women with regard to morbidity and the 6th most common with regard to mortality. Survival of patients with ovarian cancer depends on the type of surgery and the size of the residual tumour. An «aggressive» surgical approach is currently adopted in the treatment of ovarian malignancies, which is aimed at removing all visible tumour lesions and subsequent regional chemotherapy. However, outcomes of treatment remain unsatisfactory, which indicates a need for a search for new, alternative treatment methods. Intraperitoneal hyperthermic chemoperfusion is one of such methods being introduced into clinical practice. Purpose. To evaluate the effectiveness of hyperthermic chemoperfusion in complex therapy regimens for patients with advanced ovarian cancer after optimal interval surgery. Materials and methods. A retrospective, single-centre, non-randomized study was conducted at the State Budgetary Institution of Health Care Chelyabinsk Regional Clinical Centre of Oncology and Nuclear Medicine from January 2014 to February 2019. The study material included data from an observation of 61 patients diagnosed with ovarian cancer stage IIIA-C. Tumours were staged according to the FIGO / TNM classification (2009). Prior to initiation of therapy, all patients underwent an examination that included PET / CT and BRCA mutation testing. At the first stage, all subjects received 3 cycles of neoadjuvant combination chemotherapy (NACCT) according to the following regimen: paclitaxel 175 mg/m 2 and carboplatin AUC 5-6 every 3 weeks. At the second stage, all patients had cytoreductive surgery and then were divided into 3 groups. Study enrollment was sequential: Group 1 consisted of 15 subjects (24.6%) who were treated with hyperthermic intraperitoneal chemoperfusion (HIPEC) with paclitaxel 100 mg/m 2 , Group 2 included 20 patients (32.8%) receiving HIPEC with cisplatin 100 mg/m 2 , and Group 3 was composed of 26 control patients (42.6 %) who had no HIPEC. Progression-free survival, i. e., the time from the date of diagnosis to disease progression as established using objective methods, was used as the study endpoint. Study results. Treatment outcomes after first-line chemotherapy with interval surgery were analyzed. According to the RESIST 1.1 1 criteria, in Group 1 16 patients (45.7 %) had complete response, 12 subjects (34.2 %) had partial response, 4 patients (11.4%) had disease stabilization, while disease progression was observed in 3 cases (8.5%). In Group 2, complete response, partial response, disease stabilization, and progression were observed in 13 (50%), 7 (26.9%), 3 (11.5%), and 3 (11.5%) cases, respectively.