Abstract
ObjectiveTo investigate the benefit of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of endometrial peritoneal carcinomatosis compared to CRS alone.MethodsWe conducted a retrospective multicentre study of patients from experienced centres in treating peritoneal malignancies from 2002 to 2015. Patients who underwent surgery for peritoneal evolution of endometrial cancer (EC) were included. Two groups of 30 women were matched and compared: “CRS + HIPEC” which used HIPEC after CRS, and “CRS only” which did not use HIPEC. We analysed clinical, pathologic and treatment data for patients with peritoneal metastases from EC. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS).ResultsIn “CRS plus HIPEC” group, 96.7% of women were treated for recurrence, while in “CRS only” 83.3 were treated for primary disease. There was no significant difference between Peritoneal Carcinomatosis Index at laparotomy or Completeness of Cytoreduction score. Grade III and IV complications rates did not significantly differ between “CRS plus HIPEC” group and “CRS only” group (20.7% vs 20.7%, p = 0.739). Survival analysis showed no statistical difference between both groups. Median OS time was 19.2 months in “CRS plus HIPEC” group and 29.7 months in “CRS only” group (p = 0.606). Median PFS survival time was 10.7 months in “CRS plus HIPEC” group and 13.1 months in “CRS only” group (p = 0.511).ConclusionThe use of HIPEC combined to CRS did not have any significance as regard the DFS and OS over CRS alone in patients with primary or recurrent peritoneal metastasis of endometrial cancer.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries
Patient population From a multi-center international database (collaborative database of Peritoneal Surface Oncology Group International (PSOGI) and BIG-RENAPE working groups [9]), the “cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC)” group represented patients with peritoneal metastases (PM) treated with CRS and HIPEC
The mean duration of tumor progression between diagnosis of peritoneal involvement and the surgical procedure was months shorter in the “CRS only” group: 5 patients (16.7%) of “CRS only” group were treated for peritoneal recurrences whereas 1 patient (3.3%) of “CRS plus HIPEC” was treated with primary surgery
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. The overall 5-years survival reaches 95% for early detected cancers (75 to 80% of cases), nearly 10% to 15% of women with early-stage disease (International Federation of Gynaecology and Obstetrics (FIGO) stage I and II) develop recurrences [2, 3]. Advanced-stage endometrial cancers represent only 15% of newly diagnosed cases but are associated with a poor prognosis. The benefit of optimal surgical cytoreduction (CRS) in the management of advanced ovarian cancer has been established by multiple studies. Its role in management of advanced or recurrent endometrial cancer remains uncertain but significant survival benefit can be achieved with optimal resection [3, 6, 7]. CRS combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results in patients with primary peritoneal tumors such as pseudomyxoma peritonei, peritoneal mesothelioma or peritoneal metastases from colorectal, gastric, and ovarian cancer [8,9,10,11,12]
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