Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Ovarian Cancer: Experience in France

Abstract

Epithelial ovarian cancers (EOC) represent 80%–90% of all ovarian malignancies, and they are the most common cause of death for all gynecological tumors in the Western world (1). The majority of patients have an advanced Federation of Gynecology and Obstetrics (FIGO) stage III or IV disease at presentation, but the disease is often confined to the peritoneal cavity (2). Current standard treatments of these patients consist of initial cytoreductive surgery (CRS) to <1-cm residual nodules, followed by combination systemic chemotherapy with a taxane and platinum analogue, either carboplatin or cisplatin.

Our experience in France with a phase II prospective single-center study shows that the population is inhomogeneous, and >58% of patients underwent CRS and HIPEC after >2 prior recurrences and >2 laparotomies. Because of these multiple recurrences before inclusion, it was not possible to calculate the progression-free interval (PFI). In the literature, most of the series evaluating CRS alone are dedicated to secondary CRS, meaning that the patients are experiencing their first recurrence. The only feasible comparison between secondary CRS alone and this study could be on the completeness of cytoreduction, which appears as the most important prognostic factor. The present phase II study clearly underlines that combined salvage therapy can achieve long-term survival in some patients with second, third, or fourth locoregional recurrence from ovarian cancer.