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Cytoreductive Surgery and Intraperitoneal Chemotherapy for Advanced Epithelial Ovarian Cancer

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Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond

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Abstract

Advanced epithelial ovarian cancer is a disease of the peritoneal cavity that has a propensity to recur in over 75% of the cases. Maximal cytoreductive surgery (CRS) that aims at complete removal of macroscopic disease combined with systemic chemotherapy is the standard of care for these patients. Surgery should be performed as early in the course of disease as possible to obtain the maximal benefit. Hence, upfront or primary CRS is the preferred strategy. When the patient is unfit for surgery or a complete CRS is not possible, few cycles of neoadjuvant chemotherapy are administered till the disease becomes operable. Normothermic intraperitoneal chemotherapy, despite its drawbacks and complications, has shown a significant survival benefit in addition to surgery and systemic chemotherapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a logical and promising option for these patients though evidence to either support or refute its benefit is lacking. The results of randomized controlled trials in this setting are awaited. The treatment of advanced ovarian cancer is challenging; the recurrence rates continue to be high. Though response to chemotherapy is an important prognostic factor, the absolute benefit of radical surgery can be offset only in a very small percentage of patients that are complete responders. The two other important prognostic factors are the completeness of cytoreduction and the disease extent. There is a need to identify other prognostic and predictive factors in this setting for better patient selection for radical surgery and sequencing of therapies.

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Authors and Affiliations

  1. Department of Surgery, Sion Hospital (Lokmanya Tilak General Hospital), Mumbai, India

    Kayomarz Sethna

  2. Department of Surgical Oncology, Manipal Hospital, Bangalore, India

    Shabber Zaveri

  3. Department of Surgical Oncology, Fortis Hospital, Bangalore, India

    Aditi Bhatt

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  1. Kayomarz Sethna
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  2. Shabber Zaveri
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Correspondence to Kayomarz Sethna .

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  1. Department of Surgical Oncology, Fortis Hospital, Bangalore, India

    Aditi Bhatt

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Sethna, K., Zaveri, S., Bhatt, A. (2018). Cytoreductive Surgery and Intraperitoneal Chemotherapy for Advanced Epithelial Ovarian Cancer. In: Bhatt, A. (eds) Management of Peritoneal Metastases- Cytoreductive Surgery, HIPEC and Beyond. Springer, Singapore. https://doi.org/10.1007/978-981-10-7053-2_10

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