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Cytoreductive Surgery and HIPEC in Recurrent Epithelial Ovarian Cancer: A Prospective Randomized Phase III Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The current treatment of ovarian cancer consists of cytoreductive surgery (CRS) and systemic chemotherapy. The aim of this study was to examine if hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative modality to treat this category of patients along with a second attempt of surgical resection and second- or third-line systemic chemotherapy afterward.

Methods

In an 8-year period (2006–2013), 120 women with advanced ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] IIIc and IV) who experienced disease recurrence after initial treatment with conservative or debulking surgery and systemic chemotherapy were randomized into two groups. Group A comprised 60 patients treated with CRS followed by HIPEC and then systemic chemotherapy. Group B comprised 60 patients treated with CRS only and systemic chemotherapy.

Results

The mean survival for group A was 26.7 versus 13.4 months in group B (p < 0.006). Three-year survival was 75 % for group A versus 18 % for group B (p < 0.01). In the HIPEC group, the mean survival was not different between patients with platinum-resistant disease versus platinum-sensitive disease (26.6 vs. 26.8 months). On the other hand, in the non-HIPEC group, there was a statistically significant difference between platinum-sensitive versus platinum-resistant disease (15.2 vs. 10.2 months, p < 0.002). Complete cytoreduction was associated with longer survival. Patients with a peritoneal cancer index score of <15 appeared also to have longer survival.

Conclusions

The use of HIPEC along with the extent of the disease and the extent of cytoreduction play an important role in the survival of patients with recurrence in an initially advanced ovarian cancer.

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References

  1. Kurman RJ, Shih Ie M. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer—shifting the paradigm. Hum Pathol. 2011;42:918–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Surveillance, Epidemiology, and End Results (SEER). National Cancer Institute. http://seer.cancer.gov/statfacts/html/ovary.html. Accessed Aug 2014.

  3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.

    Article  PubMed  Google Scholar 

  4. Slomovitz B, Soliman P, Wolf J. Gynecologic Cancers. In: Feig B, Berger D, Fuhrman G, editors. The MD Anderson surgical oncology handbook. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.

    Google Scholar 

  5. Sugarbaker PH. Peritonectomy procedures. Cancer Treat Res. 1996;82:235–53.

    Article  CAS  PubMed  Google Scholar 

  6. Spiliotis J, Halkia E, Roukos DH. Ovarian cancer screening and peritoneal carcinomatosis: standards, “omics” and miRNAs for personalized management. Expert Rev Mol Diagn. 2011;11:465–7.

    Article  PubMed  Google Scholar 

  7. Gonzalez Bayon L, Steiner MA, Vasquez Jimenez W, Asencio JM, Alvarez de Sierra P, Atahualpa Arenas F, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial ovarian carcinoma: upfront therapy, at first recurrence, or later? Eur J Surg Oncol. 2013;39:1109–15.

  8. Mulier S, Claes JP, Dierieck V, Amiel JO, Pahaut JP, Marcelis L, 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  CAS  PubMed  Google Scholar 

  9. Helm CW, Richard SD, Pan J, Bartlett D, Goodman MD, Hoefer R, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: first report of the HYPER-O registry. Int J Gynecol Cancer. 2010;20:61–9.

    Article  PubMed  Google Scholar 

  10. van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer. N Engl J Med. 1995;332:629–34.

    Article  PubMed  Google Scholar 

  11. Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC, et al. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med. 2004;351:2489–97.

    Article  CAS  PubMed  Google Scholar 

  12. Schorge JO, Garrett LA, Goodman A. Cytoreductive surgery for advanced ovarian cancer: quo vadis? Oncology. 2011;25:928–34.

    PubMed  Google Scholar 

  13. Halkia E, Spiliotis J, Sugarbaker P. Diagnosis and management of peritoneal metastases from ovarian cancer. Gastroenterol Res Pract. 2012;2012:541842.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bakrin N, Cotte E, Golfier F, Gilly FN, Freyer G, Helm W, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for persistent and recurrent advanced ovarian carcinoma: a multicenter, prospective study of 246 patients. Ann Surg Oncol. 2012;19:4052–8.

    Article  CAS  PubMed  Google Scholar 

  15. Cotte E, Glehen O, Mohamed F, Lamy F, Falandry C, Golfier F, et al. Cytoreductive surgery and intraperitoneal chemo-hyperthermia for chemo-resistant and recurrent advanced epithelial ovarian cancer: prospective study of 81 patients. World J Surg. 2007;31:1813–20.

    Article  PubMed  Google Scholar 

  16. Raspagliesi F, Kusamura S, Campos Torres JC, de Souza GA, Ditto A, Zanaboni F, et al. Cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy in advanced/recurrent ovarian cancer patients: the experience of National Cancer Institute of Milan. Eur J Surg Oncol. 2006;32:671–5.

  17. Didelot C, Lanneau D, Brunet M, Joly AL, De Thonel A, Chiosis G, et al. Anti-cancer therapeutic approaches based on intracellular and extracellular heat shock proteins. Curr Med Chem. 2007;14:2839–47.

    Article  CAS  PubMed  Google Scholar 

  18. Hegyi G, Szigeti GP, Szasz A. Hyperthermia versus oncothermia: cellular effects in complementary cancer therapy. Evid Based Complement Altern Med. 2013;2013:672873.

    Article  Google Scholar 

  19. Bakrin N, Bereder JM, Decullier E, Classe JM, Msika S, Lorimier G, et al. Peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced ovarian carcinoma: a French multicentre retrospective cohort study of 566 patients. Eur J Surg Oncol. 2013;39:1435–43.

    Article  CAS  PubMed  Google Scholar 

  20. Spiliotis J, Vaxevanidou A, Sergouniotis F, Lambropoulou E, Datsis A, Christopoulou A. 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.

    CAS  PubMed  Google Scholar 

  21. Fagotti A, Costantini B, Petrillo M, Vizzielli G, Fanfani F, Margariti PA, 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 

  22. Stathopoulos GP, Papadimitriou C, Aravantinos G, Rigatos SK, Malamos N, Stathopoulos JG, et al. Maintenance chemotherapy or not in ovarian cancer stages IIIA, B, C, and IV after disease recurrence. J BUON. 2012;17:735–9.

    CAS  PubMed  Google Scholar 

  23. Fotopoulou C, Savvatis K, Kosian P, Braicu IE, Papanikolaou G, Pietzner K, et al. Quaternary cytoreductive surgery in ovarian cancer: does surgical effort still matter? Br J Cancer. 2013;108:32–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Fagotti A, Gallotta V, Romano F, Fanfani F, Rossitto C, Naldini A, et al. Peritoneal carcinosis of ovarian origin. World J Gastrointest Oncol. 2010;2:102–8.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. First Department of Surgical Oncology, Metaxa Cancer Hospital, Piraeus, Greece

    J. Spiliotis MD, PhD, E. Halkia MD, PhD & E. Efstathiou MD

  2. Peritoneal Surface Malignancy Unit, IASO General Hospital, Athens, Greece

    E. Halkia MD, PhD & S. Giassas MD

  3. Department of Medical Oncology, Metaxa Cancer Hospital, Piraeus, Greece

    E. Lianos MD & A. Grivas MD

  4. Department of Anesthesiology, Metaxa Cancer Hospital, Piraeus, Greece

    N. Kalantzi MD

Authors
  1. J. Spiliotis MD, PhD
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  2. E. Halkia MD, PhD
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  3. E. Lianos MD
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  4. N. Kalantzi MD
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  5. A. Grivas MD
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  6. E. Efstathiou MD
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  7. S. Giassas MD
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Corresponding author

Correspondence to J. Spiliotis MD, PhD.

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Spiliotis, J., Halkia, E., Lianos, E. et al. Cytoreductive Surgery and HIPEC in Recurrent Epithelial Ovarian Cancer: A Prospective Randomized Phase III Study. Ann Surg Oncol 22, 1570–1575 (2015). https://doi.org/10.1245/s10434-014-4157-9

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  • DOI: https://doi.org/10.1245/s10434-014-4157-9

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