Response to: “Hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer should be proposed in eight time points”

Abstract

In their letter to the Editor De Iaco and colleagues suggest new time-point for performing HIPEC considering the disease response to systemic chemotherapy. But this is not accurate in upfront treatment when disease is amenable to a front-line cytoreductive surgery. Moreover, the current definition of chemosensitivity in ovarian cancer is based on the time to recurrence since the last treatment. 1 Bukowski R.M. Ozols R.F. Markman M. The management of recurrent ovarian cancer. Semin Oncol. 2007; 34: S1-S15 Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar They suppose that HIPEC can only be effective in chemosensitive disease. But cytotoxicity mechanisms of chemotherapy by peritoneal or systemic route are dramatically different. When performing HIPEC, local concentrations of anticancer drugs are higher than in systemic route and are directly in contact of cancer cells. Moreover, hyperthermia potentiates the cytotoxic effect of anticancer drug and improves the drug penetration. 2 Glehen O. Mohamed F. Gilly F.N. Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol. 2004; 5: 219-228 Abstract Full Text Full Text PDF PubMed Scopus (313) Google Scholar Poorly vascularize tissue has been removed before ward and HIPEC target only microscopic disease. A so-called chemoresistant disease can theoretically respond to CRS and HIPEC, since the route of chemotherapy administration is different. This particularity is well illustrated by HIPEC efficacy in other peritoneal surface malignancies such as pseudomyxoma peritonei (PMP). Whereas PMP is not chemosensitive, it is efficiently treated by CRS and HIPEC. 3 Sugarbaker P.H. New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome?. Lancet Oncol. 2006; 7: 69-76 Abstract Full Text Full Text PDF PubMed Scopus (492) Google Scholar Hyperthermic Intraperitoneal Chemotherapy in Ephitelial Ovarian Cancer should be proposed in eight time pointsEuropean Journal of Surgical OncologyVol. 40Issue 8PreviewWe read with interest the article on cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) from the FROGHI group.1 This article is an interesting retrospective analysis on long term survival in patients with ovarian cancer treated with these procedures. Full-Text PDF