Advanced Recurrent Ovarian Cancer Research Articles

Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases

PurposeThe aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease.MethodsIn a retrospective Italian multicenter study investigating patients with advanced ovarian cancer who underwent CRS plus HIPEC between 1998 and 2014, we analyzed data for consecutive patients at eight treatment time points: primary debulking surgery (PDS); interval debulking surgery after partial response, after no response, and after a pathologic complete response to neoadjuvant chemotherapy; first recurrence with a progression-free interval >12, <12 months, or >12 months in patients who underwent further chemotherapy before CRS and HIPEC; and patients who underwent two or more CRS procedures and chemotherapy lines before CRS and HIPEC.ResultsThe 511 enrolled patients underwent 3373 procedures; 72.6% achieved complete cytoreduction, with an overall major morbidity of 17.4%. At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [CI] 44–58.4) and progression-free (PFS) survival was 16.6 months (95% CI 14.7–19.1). Outcome analysis in patients in whom CRS plus HIPEC was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and PFS according to the time points analyzed. Multivariate analysis identified completeness of CRS, Peritoneal Cancer Index, and the times when patients underwent CRS plus HIPEC as independent prognostic factors.ConclusionsThis selective information on survival should help in interpreting the findings from ongoing randomized studies focusing on CRS plus HIPEC in patients with advanced ovarian cancer.

900TiP - KEYNOTE-100: Phase 2 trial of pembrolizumab in patients with advanced recurrent ovarian cancer

Ovarian cancer is the most lethal gynecologic cancer, with approximately 80% of patients experiencing disease recurrence following standard front-line therapy. Currently, no curative therapy is available for recurrent ovarian cancer (ROC), which is an area with high unmet medical need. Pembrolizumab is a programmed death 1 (PD-1) inhibitor designed to directly block the interaction between PD-1 and its ligands, PD-L1 and PD-L2. This blockade enhances functional activity of the target lymphocytes to facilitate tumor regression and, ultimately, immune rejection. Prior study of pembrolizumab in advanced epithelial ovarian cancer showed promising clinical activity. Here, we further evaluate the efficacy and safety of pembrolizumab in patients (pts) with advanced ROC in the open-label, single-arm, 2-cohort KEYNOTE-100 study (NCT02674061). Trial design: Pts who are ≥18 years old with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer and confirmed disease recurrence following front-line platinum-based therapy can be enrolled. Cohort A will include approximately 250 pts who received ≤2 prior therapies for ROC and had a platinum-free interval (PFI) or treatment-free interval (TFI) of ≥3 to 12 mo based on the last regimen received. Cohort B will include approximately 75 pts who received 3-5 prior therapies for ROC and had a PFI or TFI of ≥3 mo based on the last regimen received. Pts must also have measurable disease and ECOG performance status of 0-1 at baseline and must provide a tumor sample for PD-L1 analysis. Pts will be treated with pembrolizumab 200 mg every 3 wk for 35 cycles or until disease progression, death, unacceptable toxicity, or withdrawal of consent. Pts will have regular imaging and safety assessments during the study. The primary study objectives are to evaluate objective response rate per RECIST v1.1 (primary end point) in cohort A and cohort B all-comer populations and in tumor PD-L1 high-expression populations. Duration of response, progression-free survival, overall survival, and safety will also be evaluated. Clinical trial identification: NCT02674061 Legal entity responsible for the study: Merck & Co., Inc.

First-in-human phase I/II dose-escalation study of IMAB027 in patients with recurrent advanced ovarian cancer (OVAR): Preliminary data of phase I part.

5537 Background: Ovarian cancer (OC) is a high medical need disease. Most patients (pts) relapse following initial therapy with limited therapeutic options. IMAB027 is the first-in-class monoclonal...

A first-in-human dose escalation and dose-finding phase I/II trial of IMAB027 in patients with recurrent advanced ovarian cancer (GM-IMAB-002-01).

TPS5623 Background: Ovarian cancer is a commonly diagnosed incurable disease with approximately 29,000 deaths annually. Surgery followed by platinum-based chemotherapy is the initial standard of ca...

PCN17 - A Mixed Treatment Comparison (MTC) to Compare Progression Free Survival (PFS) Associated with Different Chemotherapy Regimens for Platinum-Sensitive or Partially Platinum-Sensitive Recurrent Advanced Ovarian Cancer

PCN17 - A Mixed Treatment Comparison (MTC) to Compare Progression Free Survival (PFS) Associated with Different Chemotherapy Regimens for Platinum-Sensitive or Partially Platinum-Sensitive Recurrent Advanced Ovarian Cancer

Morbidity and mortality outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with primary and recurrent advanced ovarian cancer

BackgroundThe aim of this study is to report the perioperative outcomes of CRS and HIPEC from a single institution and review those factors that are associated with a poor perioperative outcome in patients with peritoneal dissemination from primary or recurrent ovarian cancer. Patients and methodA retrospective cohort study setting was conducted in a third level hospital peritoneal surface malignancy program. Ninety one patients diagnosed with ovarian peritoneal carcinomatosis, primary and recurrent without extraperitoneal metastasis were included for cytoreductive surgery and HIPEC with paclitaxel. We analyzed the postoperative morbidity rates and a univariate and multivariate analysis of factors associated with overall (grade I–IV) and major (grade III–IV) postoperative morbidity were performed. ResultsPeritoneal Cancer Index (PCI) upper than 12 (OR = 2.942 95%: 1.892–9.594 p = 0.044) was an independent factor associated with the occurrence of I–IV postoperative morbidity. Regarding major complications (grade III–IV), on multivariate analysis, in addition to PCI >12 (OR = 6.692, 95% CI: 1974–45, 674, p = 0.032), the need to carry out intestinal resection (OR = 4.987, 95% CI: 1350–27, 620, p = 0.046) was an independent factor related with major morbidity (grade III–IV). ConclusionsThe use of HIPEC after aggressive cytoreductive surgery in patients with ovarian cancer with peritoneal dissemination can be performed with acceptable postoperative morbidity rates. Knowledge of the factors associated with the onset of these postoperative adverse events allows better management of the same and offers the patient a safe procedure.

Clinical trials and future potential of targeted therapy for ovarian cancer

Ovarian cancer is the leading cause of death in women with gynecological cancer. Most patients are diagnosed at an advanced stage with a poor prognosis. Currently, surgical tumor debulking followed by chemotherapy based on platinum and taxane is the standard treatment for advanced disease. However, these patients remain at great risk for recurrence and developing drug resistance. Therefore, new treatment strategies are needed to improve outcomes for patients with advanced and recurrent ovarian cancer. Several agents targeted at particular molecules have been developed for ovarian cancer and are now entering clinical trials. The functional targets of these agents are aberrations in tumor tissues including angiogenesis, the human epidermal growth factor receptor family, poly(ADP-ribose) polymerase (PARP), mammalian target of rapamycin (mTOR) signaling pathway, and α-folate receptor (α-FR). The anti-angiogenic compound bevacizumab has been reported as the most effective targeted agent. Bevacizumab plus chemotherapy prolonged progression-free survival (PFS) both for advanced and platinum-sensitive recurrent ovarian cancer, but did not increase overall survival. A PARP inhibitor, olaparib, applied as maintenance treatment also improved PFS in platinum-sensitive relapsed ovarian cancer. Furthermore, mTOR inhibitors and a monoclonal antibody to α-FR, farletuzumab, are attractive treatment strategies either alone or combined with chemotherapy. Understanding the tumor molecular biology and identifying predictive biomarkers are essential steps in selecting the best treatment strategies. This article reviews available clinical data on the most promising targeted agents for ovarian cancer.

Management of Ovarian Cancer and Soft Tissue Sarcoma: Focus on Trabectedin

Ovarian cancer (OVCA) and soft tissue sarcoma (STS) are cancers that cause low survival rates when diagnosed at advanced disease stage and patients with these cancers usually suffer from recurrent disease. Trabectedin, an alkaloid of marine origin has recently demonstrated improvement in managing advanced recurrent OVCA and STS. It is currently approved as a single therapeutic agent for second line therapy of STS in the USA and Europe. It is also approved in combination with pegylated liposomal doxorubicin as a second line therapy for OVCA in Europe. This review summarizes recent clinical data demonstrating the efficacy of using trabectedin as a second line therapy in OVCA and in STS.

Feasibility of Intravenous Gemcitabine and an Intraperitoneal Platinum Agent in the Treatment of Ovarian Cancer

The goal of this study is to determine the feasibility of intravenous gemcitabine and an intraperitoneal platinum agent in the treatment of patients with ovarian cancer. We performed a retrospective chart review of patients with primary, persistent or recurrent ovarian cancer, who received intravenous gemcitabine and an intraperitoneal platinum agent. Patients received gemcitabine (750 mg/m2) intravenous on days 1 and 8 and cisplatin (100 or 60 mg/m2) intraperitoneal on day 1 every 21 - 28 days. An alternate regimen was composed of gemcitabine (750 mg/m2) intravenous and carboplatin (AUC 5) intraperitoneal on day 1 every 21 days. Dose reductions occurred at the discretion of the prescribing physician.Intravenous gemcitabine and an intraperitoneal platinum agent were administered to 12 patients with advanced primary or recurrent ovarian cancer. Myelosuppression was the most common toxicity. Grade 3 or 4 thrombocytopenia, neutropenia and anemia occurred in 7, 8 and 2 patients respectively. Dose reductions were required in 7 of 12 patients. 10 of 12 patients received 6 cycles of the regimen. Treatment was discontinued prior to 6 cycles in 2 of 12 patients secondary to progression in one case and to grade 4 neutropenia and thrombocytopenia in another.The combination of intravenous gemcitabine and an intraperitoneal platinum agent appears to be a feasible regimen in patients with ovarian cancer. The most common toxicity was myelosuppression, which resulted in dose reductions in almost half of the patients.

Comparison of the efficacy of low anterior resection with primary anastomosis and Hartmann's procedure in advanced primary or recurrent epithelial ovarian cancer

Objective We compared the efficacy between low anterior resection with primary anastomosis (LARA) and Hartmann's procedure (HP) in advanced primary or recurrent epithelial ovarian cancer (EOC). Study design We reviewed medical records of 61 patients with advanced primary or recurrent EOC who underwent LARA or HP between January 1998 and August 2008. In 37 patients with primary FIGO stage III–IV EOC, 22 and 15 received LARA and HP, whereas 10 and 14 underwent LARA and HP in 24 patients with recurrent EOC. Results Postoperative complications (recto-vaginal fistula, leakage at the anastomotic site, postoperative ileus for ≥7 days, wound dehiscence, angina pectoris, acute renal failure, febrile illness, reoperation within 30 days and postoperative death), surgical outcomes (time of operation, estimated blood loss, transfusion, postoperative hospitalization and time to normal diet) were not different between LARA and HP. Progression-free survival (median, 20 vs. 17 months) and overall survivals (median, 70 vs. 36 months) in advanced primary EOC, and surgery-specific survival (median, 32 vs. 17 months) and overall survivals (median, 52 vs. 61 months) in recurrent EOC were also not different between LARA and HP ( p > 0.05). Moreover, the recto-sigmoid obstruction after LARA was developed in 9.1% in advanced primary EOC and 10% in recurrent EOC, and the stoma-free rates were high in LARA (90.9% in advanced primary EOC; 90% in recurrent EOC). Conclusions LARA may be an optimal procedure for bowel surgery without differences in postoperative complication, surgical outcomes and survival when compared with Hartmann's procedure in advanced primary or recurrent EOC. Furthermore, the high stoma-free rate after LARA can improve postoperative quality of life by avoiding the permanent stoma formation.

Research Highlights

Research Highlights

A phase II study of erlotinib (OSI-774) given in combination with carboplatin in patients with recurrent epithelial ovarian cancer (NCIC CTG IND.149)

Objectives Approximately 50% of ovarian cancers have elevated levels of epidermal growth factor receptor (EGFR) which correlates with a poor prognosis. Preclinical evidence suggests that EGFR tyrosine kinase inhibitors (TKIs), such as erlotinib (OSI-774), may potentiate the anti-tumour effects of cytotoxic agents, including carboplatin. Blocking EGFR could thus potentially reverse drug resistance. The primary objective of the study was to assess the response rate to the addition of erlotinib in patients with recurrent ovarian cancer who were receiving carboplatin. Methods Patients enrolled on this study had either local or advanced recurrent ovarian cancer with measurable disease. They may have had up to 2 prior chemotherapy regimens, one of which must have contained platinum, and they must have responded to prior platinum therapy. Patients were stratified by platinum sensitivity and were treated with erlotinib 150 mg daily on a continuous dosing schedule, and carboplatin at an AUC of 5 every 21 days. Results Fifty patients with recurrent ovarian cancer entered the study, 33 in the platinum-sensitive arm and 17 in the platinum-resistant arm. Of patients evaluable for response, there were 14 partial responses (PR) of 30 evaluable for response (57% objective response rate (ORR)) in the platinum-sensitive arm, and 1 PR of 14 evaluable for response (7% ORR) in the platinum-resistant arm. Conclusions The combination of erlotinib and carboplatin was active in patients with platinum-sensitive disease, but not in platinum-resistant disease. The toxicities seen were those expected with carboplatin and erlotinib.

Upper abdominal surgery in advanced and recurrent ovarian cancer: Role of diaphragmatic surgery

Objective Upper abdominal spread of primary and recurrent ovarian cancer is often considered to be a major obstacle to achieve optimal residual disease at the end of surgery. In this study, we investigate the role of diaphragmatic debulking in the natural history of advanced and recurrent epithelial ovarian cancer patients, and the morbidity of this procedure according to clinico-surgical characteristics. Methods Data from 234 consecutive patients with primary and recurrent advanced ovarian cancer, operated at Catholic University of Rome and Campobasso from January 1, 2005 and December 31, 2008, were retrospectively reviewed. Results Eighty-seven patients (37.2%) underwent a diaphragmatic surgery. Median age was 55 years (range 37–76). Diaphragmatic debulking was performed in 50 out of 120 patients at primary surgery (41.7%), in 16 out of 74 at interval debulking surgery (21.6%) and in 21 out of 40 secondary cytoreductions (52.5%). In the whole study population optimal residual disease at the end of surgery was achieved. The most frequent post-operative complication was pleural effusion, observed in 37 patients (42.5%). Presence of a post-operative pleural effusion was correlated liver mobilization (52.3% vs. 16%; p < 0.0027) and large diaphragmatic disease (> 5 cm) removal (54.1% vs. 23.5%; p < 0.034). Conclusions Diaphragmatic surgery represents a crucial step in the debulking of advanced and recurrent ovarian cancer patients. Considering the natural history of advanced epithelial ovarian cancer and the rate of patients needing diaphragmatic debulking during primary cytoreduction, interval debulking surgery and secondary cytoreduction, this procedure should be present in the surgical repertoire of a gynecologic oncologist.

Laparoscopic Cytoreduction for Advanced Primary and Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Laparoscopic Cytoreduction for Advanced Primary and Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Clinical research of intraperitoneal ehemohyperthermia with NRL-002 double RF tumor hyperthermia system on recurrent ovarian cancer

Objective To study the efficacy of intraperitoneal chemohyperthermia with Double RF Tumor Hyperthermia System on recurrent ovarian cancer. Methods 22 cases of advanced recurrent ovarian cancer were infused with hot NS and DDP and VP16 in abdominal cavity, NRL-002 double RF Tumor Hyportherrnia System was applied to heat the abdominal part for 60-120 minutes. RF hyperthermia was given twice per week and chemotherapy once per week. Results The overall response rate (CR+PR) was 63.6%. The serum CA125 ratio was decreased significantly. The level of CD4/CD5 and NK cells was higher than that of pretherapy after management. The clinical beneficial response(CBR) was 81.8%. The median TIP and MST were 7.8 mouth and 18.5 month. Conclusion Intraperitoneal ehemohyporthermia with NRL-002 Double RF Tumor Hyperthermia System was an effective way to treat advanced recurrent ovarian cancer. It Can also improve life quality of patients with mild adverse effect and recommended to be applied clinically. Key words: Ovarian neoplasms; Neoplasms recurrence, local; Intraperitoneal hyperthermo chemotherapy; Prognosis

Randomized phase II study of decitabine in combination with carboplatin compared with carboplatin alone in patients with recurrent advanced ovarian cancer

5562 Background: Experimental and clinical data (Gifford et al, Clin Cancer Res. 2004) indicate the potential importance of methylation in mediating resistance to carboplatin in ovarian cancer. A previous phase I trial (Appleton et al, J Clin Oncol. 2007) established the feasibility of combining carboplatin with the demethylating agent decitabine on a day 1 + 8 q4 weekly (w) schedule and PD data provided evidence of target cell demethylation. Methods: Patients (pt) with ovarian cancer relapsing 6–12 months following first line treatment were randomised to receive either 6 cycles of carboplatin AUC 6 q4 w (Arm A), or 90 mg/m2 decitabine as a 6 hour infusion on day 1 and carboplatin AUC 6 on day 8 q4 w (Arm B). The primary endpoint was response rate. An interim analysis was planned after 11 patients were enrolled into Arm B. Results: 29 pt were enrolled. After the first 4 pt had been treated (at 90 mg/m2 decitabine) the frequency of dose delays due to neutropenia was considered unacceptable, and therefore the starting dose of decitabine was reduced to 45 mg/m2 for the subsequent 11 pt. 7 out of 14 pt in Arm A completed 6 cycles compared with 0 of 11 in Arm B (at 45 mg/m2 decitabine). Grade 2/3 hypersensitivity reactions were more common in Arm B than Arm A (64% vs. 21%), as were prolonged treatment delays due to neutropenia (36% vs. 10%). At the interim analysis, in the 11 pt treated with 45mg/m2 (Arm B), there were no RECIST responses, while 2 pt had short-lived CA125 responses (59 and 63 days). In contrast 6 of 14 patients in Arm A had RECIST responses consistent with the expected efficacy of carboplatin in this population. Conclusions: The lack of efficacy, as well as the difficulties in treatment delivery in Arm B, led the project team to conclude that the study should be closed. With this dose and schedule, decitabine is ineffective in reversing carboplatin resistance. Further investigations are ongoing to understand (a) the apparent increased incidence of hypersensitivity and (b) the trend towards reduced efficacy in Arm B. [Table: see text]

Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer – 12-year single center experience

Background The present study reviews our 12-year results with cytoreductive surgery and HIPEC in patients with advanced primary and recurrent ovarian cancer. Methods During the period from January 1995 to December 2007, 56 patients (31 with primary and 25 with recurrent epithelial ovarian cancer) underwent cytoreductive surgery and HIPEC (Doxorubicin intra-operatively, and cisplatin next 1–5 postoperative days) at our department. Results 52 (92.8%) patients had no gross residual disease after the complete surgical procedure (Sugarbaker completeness of cytoreduction CC, score 0–1), and 4 patients had macroscopic residual disease (CC-2 or CC-3) Average PCI (peritoneal cancer index) was 13.4 (4–28). Mean follow-up was 56 months (range, 1–135). The median operation time was 279 min (range 190 ± 500 min). Median total blood loss was 850 mL (range 250 ± 1550 mL). The median survival time was 34.1 months for primary, 40.1 for recurrent ovarian cancer without statistically significance difference ( p > 0.05) and median disease-free survival was 26.2 months. The PCI was equal or less than 12 in 31 patients and their median survival time was statistically significant longer than median survival time of months for the 25 patients with PCI greater then 12 ( p < 0.01). Morbidity and mortality rate were 17.8% (10/56) and 1.8% (1/56). Conclusion This series indicates that in the majority of patients with primary and recurrent advanced ovarian cancer, cytoreductive surgery combined with HIPEC can lead to a substantial increase in subsequent rates of disease-free and overall survival.

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer

With a steady incidence in the United States and worldwide, ovarian cancer remains the number one cause of death from gynecological malignancies. The conventional treatment approach for advanced ovarian malignancy is surgical debulking and systemic chemotherapy. More than 50% of these patients relapse within 5 years. For advanced primary and recurrent disease, a comprehensive approach including cytoreductive surgery and perioperative intraperitoneal chemotherapy, based on the experience with other peritoneal surface malignancies is proposed. The goal of these treatments is to surgically eradicate all visible tumor and to chemically and physically eradicate microscopic residual disease. Cytoreductive surgery includes peritonectomy procedures and visceral resections. At the Washington Cancer Institute, cisplatin and doxorubicin are administered through the intraperitoneal route with heat during the surgical procedure. In the first 5 postoperative days, patients receive normothermic intraperitoneal paclitaxel. Results of several phase II trials with this comprehensive approach suggested improved survival as compared with historical controls with reasonable morbidity and mortality.

Avoiding bevacizumab related gastrointestinal toxicity for recurrent ovarian cancer by careful patient screening

Objectives. Bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor, has demonstrated activity in recurrent ovarian carcinoma. An incidence of bowel perforation of 11% was reported in a recent phase II trial. A prior study from our institution demonstrated frequent (26%) transmural bowel wall involvement from ovarian cancer among patients who undergo intestinal resection at initial surgery. Since the initial report of this complication, we have limited bevacizumab treatment to patients without: 1) clinical symptoms of bowel obstruction 2) evidence of rectosigmoid involvement on pelvic exam 3) bowel involvement on CT scan. Methods. Patients with advanced recurrent ovarian cancer treated with single agent or combination bevacizumab therapy (15 mg/kg every 21 days) were retrospectively identified. All patients met the above criteria of no apparent bowel involvement. Toxicity was accessed using standard criteria. Objective tumor assessments and CA-125 Rustin Criteria were used to measure response and progression. Response to therapy was stratified by the presence or absence of bulky disease. Results. Twenty-five patients (21 primary ovarian cancers; 4 primary peritoneal) had received a median of 5 (range 2–12) prior chemotherapy regimens and 3 (range 1–6) prior platinum containing regimens. All patients were platinum resistant prior to bevacizumab therapy. Ten patients (40%; 95% CI: (27%, 63%)) received a median of 4 cycles (range 1–24) of bevacizumab as a single agent and 15 patients (60%; 95% CI: (41%, 77%)) received bevacizumab in combination with cytotoxic therapy. Only 4 patients (16%; 95% CI: (6%, 35%)) had bulky disease (defined as any one lesion > 5 cm) prior to bevacizumab. The overall response rate (partial response) was 28% (7 patients; 95% CI: (14%, 48%)) with a 20% (2 of 10 patients; 95% CI: (5.7%, 51%)) and 33% (5 of 15 patients; 95% CI: (15%, 58%)) response rate with bevacizumab as single agent therapy and as combination therapy, respectively. Stable disease occurred in 40% (10 patients; 95% CI: (23%, 59%)) overall, with 30% bevacizumab alone (3 of 10 patients; 95% CI: (11%, 60%)) and 47% (7 of 15 patients; 95% CI: (25%, 70%)) when in combination. The median overall survival was 9.6 months (approximate 95% CI: (7.7, ∞). There were no cases of bowel perforation or other grade 3/4 toxicities. Grade 1 and 2 toxicities included proteinuria in 7 patients (36%; 95% CI: (14%, 48%)) and hypertension in 3 patients (12%; 95% CI: (4.2%, 30%)). Conclusion. Bevacizumab demonstrates activity in recurrent platinum resistant ovarian cancer. No bowel perforations were demonstrated in our patient cohort. Such life threatening intestinal complications may be avoidable by careful patient selection even in a heavily pretreated patient population.

Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Chemoresistant and Recurrent Advanced Epithelial Ovarian Cancer: Prospective Study of 81 Patients

There is no standardized treatment for patients with chemo-resistant or recurrent advanced ovarian cancer. Locoregional treatments combining cytoreductive surgery and intraperitoneal chemohyperthermia (HIPEC) may improve survival for locoregional disease. A prospective single center study of 81 patients with recurrent or chemo-resistant peritoneal carcinomatosis from ovarian cancer was performed. Patients were treated by maximal cytoreductive surgery combined with HIPEC (with cisplatinum at 20 mg/m(2)/L). A total of 47 patients were included for their third, fourth, fifth, sixth, or seventh surgical look. Altogether, 54 patients presented with extensive carcinomatosis (malignant nodules of >5 mm). Complete macroscopic resection (CCR-0) was achieved in 45 patients. Mortality and morbidity rates were 2.5% and 13.6%, respectively. With a median follow-up of 47.1 months, the overall and disease-free median survivals were 28.4 and 19.2 months, respectively. Carcinomatosis extent and completeness of cytoreduction (p = 0.02 and p <0.001, respectively) were identified as independent prognostic factors. For CCR-0 patients, overall and disease-free survivals were 54.9 and 26.9 months, respectively. Salvage therapy combining optimal cytoreductive surgery and HIPEC may achieve long-term survival in selected patients with recurrent or chemo-resistant ovarian cancer. This strategy may be most effective in patients with limited carcinomatosis or when cytoreductive surgery provides sufficient downstaging.