Abstract
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from ovarian cancer have been shown to have a role in recurrent ovarian cancer, but are still not considered standard therapy. From March 2005 to July 2013, 41 patients who underwent 44 CRS and HIPEC for peritoneal metastases in recurrent ovarian cancer were included in this study. Details were obtained from a prospectively maintained database. Our aim was to report our 5-year overall and disease-free survivals, as well as prognostic factors for survival. Median age was 50 years old (range 23-73). Median duration of surgery was 510 min (range 230-840) and median peritoneal carcinomatosis index (PCI) score was 9.5 (range 0-31). About 92.7% of the patients had completeness of cytoreduction (CC) scores of 0 or 1. Median follow-up was 43.9 months (range 0.7-108.9). There were no mortalities and the high-grade morbidity rate was 31.8%. Median overall survival was 42.8 months (range 28.6-99.9) 5-year overall and disease-free survivals were 49.3% and 7.5% respectively. On multivariate analysis, histology and CC score were significantly associated with overall survival while histology and disease-free interval were associated with disease-free survival. The odds of developing a high-grade complication more than doubled for each additional surgical procedure performed (p=0.01). CRS and HIPEC can attain prolonged survival in selected patients with peritoneal metastasis in recurrent ovarian cancer.
Highlights
Ovarian cancer is the second most common gynecological malignancy and the commonest cause of cancer death among women [1]
*Corresponding author: Melissa Ching Ching Teo, Division of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore, E-mail: melissa.teo.c.c@singhealth.com.sg Claramae Shulyn Chia, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Cindy Lim, Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore Grace Hwei Ching Tan, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore Whay Kuang Chia, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore Khee Chee Soo, Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore associated with overall survival while histology and disease-free interval were associated with disease-free survival
Cytoreductive surgery (CRS)-HIPEC, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy; Eastern Cooperative Group (ECOG), Eastern Cooperative Oncology Group.aAmong patients with non-missing data. bAs each patient was staged according to the latest FIGO staging criteria over time, the staging data were not comparable across patients in this study if there were changes between stages across the different FIGO staging versions used. bThese patients did not receive platinum-based chemotherapy prior to their recurrence which were treated by CRS-HIPEC
Summary
Ovarian cancer is the second most common gynecological malignancy and the commonest cause of cancer death among women [1]. The disease recurs in up to 70 % of patients and long-term survival rates remain poor at 20–30 % [7, 8]. As recurrent disease is often peritoneal without evidence of systemic metastases, it is ideally suited for aggressive loco-regional therapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from ovarian cancer have been shown to have a role in recurrent ovarian cancer, but are still not considered standard therapy. Methods: From March 2005 to July 2013, 41 patients who underwent 44 CRS and HIPEC for peritoneal metastases in recurrent ovarian cancer were included in this study. Median follow-up was 43.9 months (range 0.7–108.9). Median overall survival was 42.8 months (range 28.6–99.9) 5-year overall and disease-free survivals were 49.3% and 7.5% respectively.
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