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Multicenter Study
. 2023 Nov 1;158(11):1133-1140.
doi: 10.1001/jamasurg.2023.3944.

Hyperthermic Intraperitoneal Chemotherapy After Interval Cytoreductive Surgery for Patients With Advanced-Stage Ovarian Cancer Who Had Received Neoadjuvant Chemotherapy

Jung-Yun Lee  1 , Yong Jae Lee  1 , Joo-Hyuk Son  2 , Sunghoon Kim  1 , Min Chul Choi  2 , Dong Hoon Suh  3 , Jae-Yun Song  4 , Dae Gy Hong  5 , Mi Kyung Kim  6 , Jae-Hoon Kim  7   8 , Suk-Joon Chang  9
Affiliations
Multicenter Study

Hyperthermic Intraperitoneal Chemotherapy After Interval Cytoreductive Surgery for Patients With Advanced-Stage Ovarian Cancer Who Had Received Neoadjuvant Chemotherapy

Jung-Yun Lee et al. JAMA Surg. .

Abstract

Importance: Hyperthermic intraperitoneal chemotherapy (HIPEC) followed by interval cytoreductive surgery (ICS) has shown survival benefits for patients with advanced-stage ovarian cancer. However, there is still a lack of consensus regarding the integration of HIPEC into clinical practice.

Objective: To evaluate the safety and effectiveness of ICS with HIPEC compared with ICS alone in clinical practice for patients with advanced-stage ovarian cancer.

Design, setting, and participants: This prospective, multicenter, comparative effectiveness cohort study enrolled 205 patients with stage III or IV ovarian cancer who had received at least 3 cycles of neoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC at 7 Korean Gynecologic Oncology Group institutions between September 1, 2017, and April 22, 2022. Nine patients were excluded because they did not meet the inclusion criteria.

Exposures: Neoadjuvant chemotherapy followed by ICS with HIPEC or ICS without HIPEC.

Main outcomes and measures: The primary end point was progression-free survival (PFS). Overall survival (OS) and the safety profile were the key secondary end points.

Results: This study included 196 patients (median age, 58.0 years [range, 38-82 years]), of whom 109 underwent ICS with HIPEC and 87 underwent ICS without HIPEC. The median duration of follow-up was 28.2 months (range, 3.5-58.6 months). Disease recurrence occurred in 128 patients (65.3%), and 30 patients (15.3%) died. Interval cytoreductive surgery with HIPEC was associated with a significant improvement in median PFS compared with ICS without HIPEC (22.9 months [95% CI, 3.5-58.6 months] vs 14.2 months [95% CI, 4.0-56.2 months]; P = .005) and median OS (not reached [95% CI, 3.5 months to not reached] vs 53.0 [95% CI, 4.6-56.2 months]; P = .002). The frequency of grade 3 or 4 postoperative complications was similar in both groups (ICS with HIPEC, 3 of 109 [2.8%] vs ICS without HIPEC, 3 of 87 [3.4%]; P > .99). Among patients with recurrence, the frequency of peritoneal recurrence was lower in the ICS with HIPEC group than in the ICS without HIPEC group (21 of 64 [32.8%] vs 41 of 64 [64.1%]; P = .001).

Conclusions and relevance: This study suggests that ICS in conjunction with HIPEC was associated with longer PFS and OS than ICS without HIPEC for patients with advanced-stage ovarian cancer and was not associated with higher rates of postoperative complications. The lower rate of peritoneal recurrence after HIPEC may be associated with improved OS.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Patients
HIPEC indicates hyperthermic intraperitoneal chemotherapy; ICS, interval cytoreductive surgery; and NAC, neoadjuvant chemotherapy.
Figure 2.
Figure 2.. Kaplan-Meier Curves of Progression-Free Survival (PFS) and Overall Survival (OS) According to Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
HR indicates hazard ratio; ICS, interval cytoreductive surgery; and NR, not reached.
See this image and copyright information in PMC

References

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