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Survival Benefit of Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Cancer: A Multi-institutional Case Control Study

  • Gynecologic Oncology
  • Published:
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Abstract

Background

Hyperthermic intraperitoneal chemotherapy (HIPEC) and complete surgical removal of the tumor, in relapsing patients may provide a clinical benefit. There is no consensus considering the place of HIPEC for patients who had first ovarian cancer relapse. To assess for possible efficacy of HIPEC on overall survival (OS) rates in this situation, we performed a multi-institutional study.

Methods

The current study was a retrospective case control multi-institutional study comparing a group of patients treated with HIPEC to a group of patients treated without HIPEC. Inclusion criteria were first relapse of a serous ovarian carcinoma and >6 months after the end of initial treatment. Exclusion criteria were another pathological subtype of ovarian cancer, a relapse at <6 months after initial treatment, and a second relapse or more. We aimed to assess OS, morbidity, and mortality rates and prognostic factors.

Results

From June 1997–July 2011, 42 patients were included, 23 in the HIPEC group and 19 in the control group. Each patient from the two groups had a complete secondary surgery at the time of the first relapse. At 4 years OS was 75.6 % in the HIPEC group and 19.4 % in the control group (p = 0.013). In a multivariate analysis, HIPEC and interval-free before the end of initial treatment were both independent prognostic factors.

Conclusion

When compared to the control group, complete secondary surgery and HIPEC appear to afford a better OS rate than complete secondary surgery alone, in case of first ovarian cancer relapse. Further randomized trials are warranted to confirm these results.

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References

  1. Guerin S, Doyon F, Hill C. [The frequency of cancer in France in 2006, mortality trends since 1950, incidence trends since 1980 and analysis of the discrepancies between these trends]. Bull Cancer. 2009;96:51–7.

    PubMed  CAS  Google Scholar 

  2. Leitao MM, Jr., Kardos S, Barakat RR, Chi DS. Tertiary cytoreduction in patients with recurrent ovarian carcinoma. Gynecol Oncol. 2004;95:181–8.

    Article  PubMed  Google Scholar 

  3. Parmar MK, Ledermann JA, Colombo N, et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. 2003; 361: 2099–106.

    Article  PubMed  CAS  Google Scholar 

  4. Berek JS, Hacker NF, Lagasse LD, Nieberg RK, Elashoff RM. Survival of patients following secondary cytoreductive surgery in ovarian cancer. Obstet Gynecol. 1983;61:189–93.

  5. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol. 2009;112:265–74.

    Article  PubMed  Google Scholar 

  6. Harter P, Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13:1702–10.

    Article  PubMed  Google Scholar 

  7. Classe JM, Jaffre I, Frenel JS, et al. Prognostic factors for patients treated for a recurrent FIGO stage III ovarian cancer: a retrospective study of 108 cases. Eur J Surg Oncol. 2011;37:971–7.

    Article  PubMed  CAS  Google Scholar 

  8. Fulham MJ, Carter J, Baldey A, et al. The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol. 2009;112:462–8.

    Article  PubMed  CAS  Google Scholar 

  9. Skaznik-Wikiel ME, Lesnock JL, McBee WC, et al. Intraperitoneal chemotherapy for recurrent epithelial ovarian cancer is feasible with high completion rates, low complications, and acceptable patient outcomes. Int J Gynecol Cancer. 2012;22:232–7.

    Article  PubMed  Google Scholar 

  10. Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34–43.

    Article  PubMed  CAS  Google Scholar 

  11. Helm CW. Current status and future directions of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of ovarian cancer. Surg Oncol Clin N Am. 2012;21:645–63.

    Article  PubMed  Google Scholar 

  12. Spratt JS, Adcock RA, Muskovin M, et al. Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 1980;40:256–60.

    PubMed  CAS  Google Scholar 

  13. Los G, Verdegaal EM, Mutsaers PH, McVie JG. Penetration of carboplatin and cisplatin into rat peritoneal tumor nodules after intraperitoneal chemotherapy. Cancer Chemother Pharmacol. 1991;28:159–65.

    Article  PubMed  CAS  Google Scholar 

  14. Chua TC, Yan TD, Saxena A, Morris DL. Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure?: a systematic review of morbidity and mortality. Ann Surg. 2009;249:900–7.

    Article  PubMed  Google Scholar 

  15. Mulier S, Claes JP, Dierieck V, et al. Survival benefit of adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the different time-points of treatment of ovarian cancer: review of evidence. Curr Pharm Des. 2012;18:3793–803.

    Article  PubMed  CAS  Google Scholar 

  16. Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol. 1999;43 Suppl:S15–25.

    Article  PubMed  Google Scholar 

  17. Munoz-Casares FC, Rufian S, Rubio MJ, et al. The role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis in recurrent ovarian cancer. Clin Transl Oncol. 2009;11:753–9.

    Article  PubMed  Google Scholar 

  18. Fagotti A, Costantini B, Petrillo M, et al. Cytoreductive surgery plus HIPEC in platinum-sensitive recurrent ovarian cancer patients: a case-control study on survival in patients with two year follow-up. Gynecol Oncol. 2012;127:502–5.

    Article  PubMed  Google Scholar 

  19. Spiliotis J, Vaxevanidou A, Sergouniotis F, et al. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent advanced ovarian cancer: a prospective study. J Buon. 2011;16:74–9.

    PubMed  CAS  Google Scholar 

  20. Winter WE, 3rd, Maxwell GL, Tian C, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621–7.

    Article  PubMed  Google Scholar 

  21. Chi DS, McCaughty K, Diaz JP, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006;106:1933–9.

    Article  PubMed  Google Scholar 

  22. Fagotti A, Fanfani F, Rossitto C, et al. A treatment selection protocol for recurrent ovarian cancer patients: the role of FDG-PET/CT and staging laparoscopy. Oncology. 2008;75:152–8.

    Article  PubMed  CAS  Google Scholar 

  23. Friberg G, Fleming G. Intraperitoneal chemotherapy for ovarian cancer. Curr Oncol Rep. 2003;5:447–53.

    Article  PubMed  Google Scholar 

  24. Chua TC, Robertson G, Liauw W, et al. Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol. 2009;135:1637–45.

    Article  PubMed  Google Scholar 

  25. Markman M. Hyperthermic intraperitoneal chemotherapy in the management of ovarian cancer: A critical need for an evidence-based evaluation. Gynecol Oncol. 2009;113:4–5.

    Article  PubMed  Google Scholar 

  26. Chatzigeorgiou K, Economou S, Chrysafis G, et al. Treatment of recurrent epithelial ovarian cancer with secondary cytoreduction and continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP). Zentralbl Gynakol. 2003;125:424–9.

    Article  PubMed  CAS  Google Scholar 

  27. Zanon C, Clara R, Chiappino I, et al. Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg. 2004;28:1040–5.

    Article  PubMed  Google Scholar 

  28. Deraco M, Virzi S, Iusco DR, et al. Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi-institutional study. BJOG. 2012;119:800–9.

    Article  PubMed  CAS  Google Scholar 

  29. Ceelen WP, Van Nieuwenhove Y, Van Belle S, et al. Cytoreduction and hyperthermic intraperitoneal chemoperfusion in women with heavily pretreated recurrent ovarian cancer. Ann Surg Oncol. 2012;19:2352–9.

    Article  PubMed  Google Scholar 

  30. Argenta PA, Sueblinvong T, Geller MA, et al. Hyperthermic intraperitoneal chemotherapy with carboplatin for optimally-cytoreduced, recurrent, platinum-sensitive ovarian carcinoma: a pilot study. Gynecol Oncol. 2013;129:81–5.

    Article  PubMed  CAS  Google Scholar 

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Disclosure

The authors have no commercial interest to disclose.

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Authors and Affiliations

  1. Institut de cancérologie de l’Ouest, Saint-Herblain, France

    Jean-François Le Brun MD, Loic Campion MD, Dominique Berton-Rigaud MD, François Dravet MD, Isabelle Jaffre MD & Jean-Marc Classe MD, PhD

  2. ICO Paul Papin, Angers, France

    Gérard Lorimier MD & Anne Sophie Oger MD

  3. ICL Alexis Vautrin, Vandoeuvre Les Nancy, France

    Frédéric Marchal MD, PhD

  4. Institut Claudius Regaud, Toulouse, France

    Gwenael Ferron MD

Authors
  1. Jean-François Le Brun MD
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  2. Loic Campion MD
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  3. Dominique Berton-Rigaud MD
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  4. Gérard Lorimier MD
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  5. Frédéric Marchal MD, PhD
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  6. Gwenael Ferron MD
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  7. Anne Sophie Oger MD
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  8. François Dravet MD
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  9. Isabelle Jaffre MD
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  10. Jean-Marc Classe MD, PhD
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Corresponding author

Correspondence to Jean-Marc Classe MD, PhD.

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Le Brun, JF., Campion, L., Berton-Rigaud, D. et al. Survival Benefit of Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Cancer: A Multi-institutional Case Control Study. Ann Surg Oncol 21, 3621–3627 (2014). https://doi.org/10.1245/s10434-014-3693-7

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  • DOI: https://doi.org/10.1245/s10434-014-3693-7

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