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Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer: First Report of the HYPER-O Registry
  1. Cyril William Helm, MB, BChir*,
  2. Scott D. Richard, MD,
  3. Jianmin Pan, MD,
  4. David Bartlett, MD§,
  5. Martin D. Goodman, MD,
  6. Rick Hoefer, DO, FACS,
  7. Sam S. Lentz, MD**,
  8. Edward A. Levine, MD††,
  9. Brian W. Loggie, MD‡‡,
  10. Daniel S. Metzinger, MD*,
  11. Brigitte Miller, MD**,
  12. Lynn Parker, MD*,
  13. James E. Spellman, MD§§,
  14. Paul H. Sugarbaker, MD, FACS, FRCS∥∥,
  15. Robert P. Edwards, MD¶¶ and
  16. Shesh N. Rai, MD***,†††
  1. *Division of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY;
  2. University of Pittsburgh Physicians, Department of Obstetrics, Gynecology and Women's Health, Magee-Women's Hospital, Pittsburgh, PA;
  3. Biostatistics Shared Facility, James Graham Brown Cancer Center, University of Louisville, Louisville, KY;
  4. §Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA;
  5. Tufts Medical Center, Boston, MA;
  6. Surgical Oncology Newport News, VA; Divisions of
  7. **Gynecologic Oncology, and
  8. ††Surgical Oncology, Wake Forest University, Winston-Salem, NC;
  9. ‡‡Division of Surgical Oncology, Creighton University Medical Center, Omaha, NE;
  10. §§Oncologic Surgery, Beebe Medical Center, Rehoboth Beach, DE;
  11. ∥∥Washington Hospital Center, Washington, DC;
  12. ¶¶Magee Hospital for Women, Pittsburgh, PA; and
  13. ***Biostatistics Shared Facility, James Graham Brown Cancer Center, and
  14. †††Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY.
  1. Address correspondence and reprint requests to C. William Helm, MB, BChir, Division of Gynecologic Oncology, James Graham Brown Cancer Center, Third Floor, 529 S Jackson St, Louisville, KY 40202. E-mail: cwilliamhelm{at}gmail.com.

Abstract

Introduction: An analysis of experience of surgical and gynecologic oncologists in the United States with the use of hyperthermic intraperitoneal chemotherapy for women with invasive epithelial ovarian cancer (EOC).

Methods: An Internet-based registry (HYPER-O) collected data from collaborating institutions. Eligibility included women with EOC treated with hyperthermic intraperitoneal chemotherapy. Borderline and nonepithelial cancers were excluded.

Results: As of July 1, 2008, 141 women were eligible for analysis treated at the following time points: frontline (n = 26), interval debulking (n = 19), consolidation (n = 12), and recurrence (n = 83). The mean perfusion temperatures were 38.5 to 43.6°C (median, 41.9°C) for inflow and 36.9 to 42.9°C (median, 41°C) for outflow for 30 to 120 minutes. Treatment was with a platinum agent (n = 72), mitomycin (n = 53), or a combination (n = 14). Median follow-up was 18 months (range, 0.3-140.5 months) and median overall survival 30.3 months (95% confidence interval, 23.0-37.6) with 2-, 5-, and 10-year overall survival probabilities of 49.1%, 25.4%, and 14.3%, respectively. Of the 141 patients, 110 (78%) experienced recurrence of ovarian cancer and 87 died, 3 (0.5%) dying within 30 days of surgery. In the multivariable analysis, the factors significant for increased survival were sensitivity to platinum response (P = 0.048), completeness of cytoreduction scores of 1 or 0 (P = 0.025), carboplatin alone or a combination of 2 or more chemotherapy agents used (P = 0.011), and duration of hospital stays of 10 days or less (P = 0.021).

Conclusions: Hyperthermic intraperitoneal chemotherapy is a viable additional treatment option for patients with invasive EOC and may extend life in selected groups. It warrants further study in randomized controlled trials.

  • Hyperthermic intraperitoneal chemotherapy (HIPEC)
  • Ovarian neoplasms
  • Intraperitoneal chemotherapy
  • Hyperthermia
  • Cytoreductive surgery

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Footnotes

  • Dr Helm has received 3 honoraria for lectures on hyperthermic intraperitoneal chemotherapy in ovarian cancer from ThermaSolutions, Inc (White Bear Lake, Minn).

  • Dr Helm has received grant support from ThermaSolutions, Inc for the HYPER-O registry and from Sanofi-Aventis (Bridgewater, NJ) for a clinical research study investigating hyperthermic intraperitoneal chemotherapy.

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