Long Terms Outcome After Cytoreductive Surgery Combined with Hyperthermic intraperitoneal Chemotherapy (HIPEC) in the Treatment of Recurrent Ovarian Cancer

Abstract

Background: Recurrent ovarian cancer is often associated with peritoneal carcinomatosis (PC) which is longer considered expression of systemic disease not amenable of curative treatment. Contrariwise recurrent ovarian cancer may be considered as an “intraperitoneal disease” by itself, susceptible to locoregional treatment. Cytoreductive surgery and intravenous chemotherapy have been the cornerstone for a long time to treat this disease. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) along with radical surgery/peritonectomy represent a new therapeutic approach with curative intention. This method is based on the presence of the peritoneal-plasmatic barrier that holds back high molecular weight drugs, keeping from passing at the systemic circulation; in this way it is possible to use higher and more concentrate chemo-drug doses in a very limited area than in the systemic chemotherapy. The association between chemotherapy and hyperthermia produces a synergic effect: hyperthermia, infarct, makes chemo-drugs more effective and selective, improving their capability of penetration in tumoral masses; heat has furthermore an intrinsic anti-neoplastic action, being altered the reparation mechanisms of the tumoral cells. Whereas the extent of intraperitoneal tumor dissemination and the completeness of cytoreduction are the leading predictors of postoperative patient outcome, the preoperative patient selection are crucial to obtain best result from cytoreductive treatment and HIPEC. In our experience, along the lines of the literature, we tried to define which patients affected from recurrent ovarian cancer might be considered the ideal candidates for this procedure.