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. 2017 Sep;116(3):320-328.
doi: 10.1002/jso.24666. Epub 2017 Jun 19.

Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer

Deepa Magge  1 , Lekshmi Ramalingam  1 , Yongli Shuai  2 , Robert P Edwards  1   3 , James F Pingpank  1 , Steven S Ahrendt  1 , Matthew P Holtzman  1 , Herbert J Zeh  1 , David L Bartlett  1 , Haroon A Choudry  1
Affiliations

Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer

Deepa Magge et al. J Surg Oncol. 2017 Sep.

Abstract

Background and objectives: The role of hyperthermic intraperitoneal chemoperfusion (HIPEC) in the multimodality treatment of ovarian peritoneal metastases (OPM) and primary peritoneal cancer (PPC) remains controversial. We hypothesized that cytoreductive surgery (CRS) and HIPEC would provide meaningful survival benefit without excessive morbidity.

Methods: We reviewed clinicopathologic and perioperative data following 96 CRS-HIPEC procedures for primary or recurrent OPM and PPC. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes.

Results: CRS-HIPEC was mostly performed for recurrent disease (56.3%) and high-grade serous carcinoma (72.9%). Platinum-based systemic chemotherapy was administered to 89.5% of patients, with 75.5% having platinum-sensitive disease at CRS-HIPEC. Complete macroscopic resection was achieved in 70.8% of patients. Clavien-Dindo grade 3/4 morbidity occurred in 23.4% of patients; three patients died within 60-days postoperatively. Median overall survival from diagnosis of peritoneal metastases and CRS-HIPEC was 78 and 38 months, respectively. Completeness of cytoreduction, pathologic subtype, and 30-day morbidity were independent predictors of survival in multiple regression analysis.

Conclusions: Our study demonstrates promising survival data and supports the role of HIPEC in the multimodality treatment algorithm for primary or recurrent OPM and PPC. However definite indications and timing of HIPEC need to be clarified by prospective studies.

Keywords: HIPEC multimodality; cisplatin; cytoreductive surgery; ovarian cancer; primary peritoneal cancer.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curve for patients with ovarian high-grade serous carcinoma treated with multimodality therapy including cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemoperfusion (HIPEC) and systemic chemotherapy (n=62). The estimated median overall survival from CRS-HIPEC was 38 months (95% CI 25.3 to 53.7 months) for CC-0 resection, 12.2 months (95% CI 4.9 to 21.3 months) for CC-1 resection, and 6.5 months (95% CI 1.0 to 56.2 months) for CC-2/3 resection.
Figure 2
Figure 2
Kaplan-Meier survival curve for patients with ovarian high-grade serous carcinoma treated with multimodality therapy including cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemoperfusion (HIPEC) and systemic chemotherapy (n=62). The estimated median overall survival from CRS-HIPEC was 27.4 months (95% CI 22.3 to 47.9 months) for treatment of recurrent disease, and 53.7 months (95% CI 12.2 to - months) for initial treatment of the disease.
Figure 3
Figure 3
Kaplan-Meier survival curve for patients with ovarian high-grade serous carcinoma treated with multimodality therapy including cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemoperfusion (HIPEC) and systemic chemotherapy (n=62). The estimated median overall survival from CRS-HIPEC was 38.0 months (95% CI 21.3 to 68.9 months) for platinum-sensitive disease (“platsensitive”), and 37.2 months (95% CI 0.9 to 65.1 months) for platinum-resistant or refractory disease (“platresistrefract”).
Figure 4
Figure 4
Kaplan-Meier survival curve for patients with ovarian high-grade serous carcinoma treated with multimodality therapy including cytoreductive surgery (CRS)-hyperthermic intraperitoneal chemoperfusion (HIPEC) and systemic chemotherapy (n=62). The estimated median overall survival from CRS-HIPEC was 50 months (95% CI 25.7 to 104.6 months) for patients without 30-day postoperative morbidity, and 22.3 months (95% CI 12.5 to 28.4 months) for patients with 30-day postoperative morbidity.
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