Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Recurrent Advanced Ovarian Carcinoma: Initial Experience in Mexico

Abstract

Background: Ovarian cancer is a lethal tumor, 70% of which occurs in locally advanced stages. Despite its high initial response rate to chemotherapy, recurrence takes place in up to 90%. Prognosis of recurrent disease remains poor. In recent years, a new approach has been developed, combining a maximal cytoreductive effort with Hyperthermic intraperitoneal chemotherapy (HIPEC).Methods: We conducted a pilot study of 14 patients with recurrent ovarian cancer who were treated with Cytoreductive surgery (CRS) and HIPEC at the Mexico City-based National Cancer Institute of Mexico (INCan) between January 2007 and January 2012.Results: There were 14 patients with recurrent ovarian cancer, including 13 with clinical stage IIIC and one with clinical stage CEIV due to retroperitoneal tumor with recurrence. Average age was 52 years (range, 20–72 years). Mortality and morbidity rates were 0 and 40%, respectively. Average surgical operative time was 7.5 h (range, 4.7–11 h). Average bleeding amounted to 1,171 mL (range, 100–3,700 mL).Overall median survival (OMS) was 14 months (range, 2–37 months). Peritoneal carcinomatosis index (PCI) showed eight patients with 20 points. Bleeding correlates with the PCI of >20 points. Performance status was a significant prognostic factor in patients with extensive peritoneal carcinomatosis (PCI, >20).Conclusions: Therapy combining CRS and HIPEC is feasible in selected patients with recurrent ovarian carcinoma with high morbidity. With ovarian cancer, novel therapies should be explored, one of which could be HIPEC.