Ten-year survival for patients with epithelial ovarian cancer treated with consolidation hyperthermic intraperitoneal chemotherapy (331)

Abstract

<b>Objectives:</b> We aimed to evaluate the long-term efficacy of consolidation hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with epithelial ovarian cancer. <b>Methods:</b> This retrospective study included patients who received consolidation HIPEC at Seoul St. Mary's Hospital between January 1991 and December 2003. Consolidation HIPEC was performed during the second-look operation for patients who had a complete or partial response after primary cytoreductive surgery (CRS) and adjuvant platinum-based chemotherapy. HIPEC was performed by perfusion of 6L of lactated Ringer's solution and paclitaxel 175 mg/m² or carboplatin 350 mg/m² at 43-44°C for 90 minutes. Ten-year progression-free survival (PFS) and overall survival (OS) were analyzed and compared with patients who underwent second-look operation without HIPEC. <b>Results:</b> A total of 87 patients were included. Of these, 44 patients (50.6%) received consolidation HIPEC, and the other 43 (49.4%) received second-look operation only (No HIPEC). The 10-year PFS rate was significantly longer in the HIPEC group compared to the control group (59.1% vs 34.9%, p=0.032), and there was a marginal significance in the 10-year OS rate between the two groups (59.1% vs 37.2%, p=0.054). In a subgroup of patients with stage III, HIPEC group showed significantly longer 10-year PFS and OS rate compared with the control group (PFS: 53.8% vs 14.8%, p=0.001; OS: 38.5% vs 11.1%, p=0.036). Multivariate analysis identified HIPEC as an independent favorable prognostic factor for the 10-year PFS (adjusted HR: 0.49, 95% CI: 0.25-0.96, p=0.039), although not for the 10-year OS (adjusted HR: 0.60, 95% CI: 0.31-1.17, p=0.133). Patients who underwent HIPEC with paclitaxel showed a trend of higher PFS and OS compared with those who underwent HIPEC with carboplatin, although the result was not statistically significant (PFS: adjusted HR: 0.39, 95% CI: 0.13-1.2, p=0.102; OS: adjusted HR: 0.31, 95% CI: 0.03-1.1, p=0.070). Adverse events more common in the HIPEC group included thrombocytopenia, elevated liver enzyme, and wound complications. However, these adverse events were reversible and did not delay subsequent consolidation chemotherapy. <b>Conclusions:</b> The consolidation HIPEC demonstrated a significant improvement in 10-year PFS and a marginally significant improvement in 10-year OS in patients with epithelial ovarian cancer, with acceptable toxicity. Fig. 1