Robotic and Open Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in the Management of Recurrent Ovarian Cancer

Abstract

INTRODUCTION: We aimed to evaluate the feasibility and tolerability of hyperthermic intraperitoneal chemotherapy after cytoreduction surgery for recurrent ovarian cancer. METHODS: In a single-institution, pilot study, patients underwent optimal cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy followed by consolidation chemotherapy from September 2011 to May 2013. Optimal cytoreduction was defined as no lesion greater than 1 cm. Adverse and oncologic outcomes were measured. Standard statistical analysis was used. RESULTS: Thirteen patients with a median age of 52 years (range 20–86 years) were identified. The median number of chemotherapy regimens before hyperthermic intraperitoneal chemotherapy was three (range one to 12 prior regimens). A median of two platinum-containing regimens was administered before hyperthermic intraperitoneal chemotherapy (range zero to five regimens). Median CA-125 at time of hyperthermic intraperitoneal chemotherapy was 256 U/mL (range 13–8,543 U/mL). Seven (54%) of patients were platinum-sensitive at the time of hyperthermic intraperitoneal chemotherapy. Six (46%) patients underwent a robotic optimal cytoreductive surgery. The following cytotoxic agents were used during hyperthermic intraperitoneal chemotherapy: mitomycin, six (46%); cisplatin and paclitaxel, four (31%); carboplatin, two (15%); and paclitaxel, one (8%). There were no intraoperative complications or adverse events attributable to hyperthermic intraperitoneal chemotherapy therapy. Hospital stay was a median of 8 days (range 1–25 days). At a median follow-up of 4 months (range 1–7 months), the progression-free survival and overall survivals have not been reached. CONCLUSIONS: In select patients, robotic and open cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy is feasible and safe. The optimal candidate and chemotherapy regimen have yet to be defined. Preliminary survival data suggest efficacy.