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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review

  • Clemens B. TempferEmail author
  • Peter Kern
  • Askin Dogan
  • Ziad Hilal
  • Günther A. Rezniczek
Research Paper
  • 18 Downloads

Abstract

Cytoreductive surgery (CRS) is an appropriate treatment for selected patients with endometrial cancer (EC)-derived peritoneal metastases (PM). Hyperthermic intraperitoneal chemotherapy (HIPEC) may enhance the therapeutic efficacy of CRS in these patients. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials and case reports reporting on the safety and efficacy of CRS and HIPEC in patients with EC-derived PM. Eight publications reporting on 68 patients were identified. The mean patient age was 57.1 years and the mean time from initial treatment of EC to CRS and HIPEC was 22.3 months. 41/64 patients had adenocarcinomas, type II cancers were present in 23/64 patients. The mean peritoneal carcinomatosis index (PCI) was 16.7. A complete surgical resection CC-0 was achieved in 44/63 (70%) patients. The chemotherapy regimens used for HIPEC were variable, but all included cisplatin, administered either alone (39/68 patients) or combined with doxorubicin or paclitaxel or mitomycin (29/68 patients). The duration of HIPEC was 60 min in 51/68 patients and 90 min in 17/68 patients. Mostly, the closed technique was used (55/68 patients). Adverse events grades 1/2, 3, and 4 were observed in 23/63, 12/63, and 6/63 patients, respectively. Treatment-associated mortality was 1% (1/63). After CRS and HIPEC, most patients received systemic chemotherapy (46/63 patients). Median disease-free and overall survival ranged from 7 to 18 and 12 to 33 months, respectively. In conclusion, CRS and HIPEC in EC with PM is safe and feasible. An additional therapeutic value of HIPEC is suggested, but prospective comparative trials are warranted.

Keywords

Endometrial cancer Peritoneal metastasis Chemotherapy HIPEC Hyperthermic chemotherapy Intraperitoneal chemotherapy 

Abbreviations

Adeno-CA

Adenocarcinoma

CC

Complete cytoreduction

CD

Clavien-Dindo classification

CIS

Cisplatin

COS

Cohort study

CR

Case report

CRS

Cytoreductive surgery

CS

Case series

CTCAE

Common toxicity criteria for adverse events

DFS

Disease-free survival

DOXO

Doxorubicin

EC

Endometrial cancer

HIPEC

Hyperthermic intraperitoneal chemotherapy

ICU

Intensive care unit

MITO

Mitomycin

OS

Overall survival

PAC

Paclitaxel

PM

Peritoneal metastases

PCI

Peritoneal carcinomatosis index

Notes

Authors' contributions

CBT and AD collected data and wrote the manuscript. GAR analyzed the data. ZH and PK provided critical contributions to the manuscript. All authors participated in discussion and revision of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsRuhr-Universität BochumBochumGermany
  2. 2.Comprehensive Cancer Center of the Ruhr-Universität Bochum (RUCCC)BochumGermany
  3. 3.Department of Gynecology and Obstetrics, St. Elisabeth-KrankenhausRuhr-Universität BochumBochumGermany
  4. 4.Marien Hospital HerneHerneGermany

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