Abstract
BackgroundFor recurrent disease or primary therapy of advanced ovarian cancer, cytoreductive surgery (CRS) followed by adjuvant chemotherapy is a therapeutic option. The aim of this study was to evaluate the outcome for patients with epithelial ovarian cancer treated with hyperthermic intraoperative chemotherapy (HIPEC) and completeness of cytoreduction (CC).MethodsData were retrospectively collected from 111 patients with recurrent or primary ovarian cancer operated with the contribution of visceral surgical oncologists between 1991 and 2006 in a tertiary referral hospital.ResultsNinety patients received CRS and 21 patients CRS plus HIPEC with cisplatin. Patients with complete cytoreduction (CC0) were more likely to receive HIPEC. Overall, 19 of 21 patients (90.5 %) with HIPEC and 33 of 90 patients (36.7 %) with CRS had a complete cytoreduction (P < 0.001). Incomplete cytoreduction was associated with worse survival rates with a hazard ratio (HR) of 4.4 (95%CI: 2.3-8.4) for CC1/2 and 6.0 (95%CI: 2.9-12.3) for CC3 (P < 0.001). In a Cox-regression limited to 52 patients with CC0 a systemic concomitant chemotherapy (HR 0.3, 95%CI: 0.1-0.96, P = 0.046) but not HIPEC (HR 0.98 with 95 % CI 0.32 to 2.97, P = 0.967) improved survival. Two patients (9.5 %) developed severe renal failure after HIPEC with absolute cisplatin dosages of 90 and 95 mg.ConclusionsCompleteness of cytoreduction was proved to be crucial for long-term outcome. HIPEC procedures in ovarian cancer should be performed in clinical trials to compare CRS, HIPEC and systemic chemotherapy against CRS with systemic chemotherapy. Concerning the safety of HIPEC with cisplatin, the risk of persistent renal failure must be considered when dosage is based on body surface.
Highlights
Epithelial ovarian cancer is primarily diagnosed in the advanced stage III or IV, as defined by FIGO (International Federation of Gynaecology and Obstetrics), and 75 % of these patients present with peritoneal carcinomatosis as a typical finding [1]
cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) has proved feasible, it is associated with morbidity rates ranging from 0 % to 40 % and mortality rates ranging from 0 % to 10 % [8,9,10,11]
hyperthermic intraoperative chemotherapy (HIPEC) after CRS was proposed as the “up-front treatment” for ovarian cancer with peritoneal carcinomatosis [1], which was substantially criticized by others [12]
Summary
Epithelial ovarian cancer is primarily diagnosed in the advanced stage III or IV, as defined by FIGO (International Federation of Gynaecology and Obstetrics), and 75 % of these patients present with peritoneal carcinomatosis as a typical finding [1]. For recurrent disease or primary therapy of advanced ovarian cancer (FIGO III and IV), cytoreductive surgery (CRS) followed by an adjuvant chemotherapy is the standardized therapeutic option [7]. The abundant heterogeneity in study populations cannot be prevented because of individual patient selection for HIPEC by operating surgeons and the presumably variable and individually determined surgical aggressiveness applied to gain complete cytoreduction. Results of this treatment modality have been shown to be beneficial for patients with peritoneal carcinomatosis from appendix cancer, applying the same criteria for cytoreduction and methods for HIPEC [15,16,17]. The aim of this study was to evaluate the outcome for patients with epithelial ovarian cancer treated with hyperthermic intraoperative chemotherapy (HIPEC) and completeness of cytoreduction (CC)
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