Top

Published in:

01-09-2007

Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Chemoresistant and Recurrent Advanced Epithelial Ovarian Cancer: Prospective Study of 81 Patients

Authors: Eddy Cotte, Olivier Glehen, Faheez Mohamed, Franck Lamy, Claire Falandry, François Golfier, Francois Noel Gilly

Published in: World Journal of Surgery | Issue 9/2007

Abstract

Purpose

There is no standardized treatment for patients with chemoresistant or recurrent advanced ovarian cancer. Locoregional treatments combining cytoreductive surgery and intraperitoneal chemohyperthermia (HIPEC) may improve survival for locoregional disease.

Patients and methods

A prospective single center study of 81 patients with recurrent or chemoresistant peritoneal carcinomatosis from ovarian cancer was performed. Patients were treated by maximal cytoreductive surgery combined with HIPEC (with cisplatinum at 20 mg/m²/L). A total of 47 patients were included for their third, fourth, fifth, sixth, or seventh surgical look. Altogether, 54 patients presented with extensive carcinomatosis (malignant nodules of >5 mm).

Results

Complete macroscopic resection (CCR-0) was achieved in 45 patients. Mortality and morbidity rates were 2.5% and 13.6%, respectively. With a median follow-up of 47.1 months, the overall and disease-free median survivals were 28.4 and 19.2 months, respectively. Carcinomatosis extent and completeness of cytoreduction (p = 0.02 and p <0.001, respectively) were identified as independent prognostic factors. For CCR-0 patients, overall and disease-free survivals were 54.9 and 26.9 months, respectively.

Conclusion

Salvage therapy combining optimal cytoreductive surgery and HIPEC may achieve long-term survival in selected patients with recurrent or chemoresistant ovarian cancer. This strategy may be most effective in patients with limited carcinomatosis or when cytoreductive surgery provides sufficient downstaging.

Bonnefoi H, A’Hern RP, Fisher C, et al. (1999) Natural history of stage IV epithelial ovarian cancer. J Clin Oncol 17:767–775PubMed

Randall TC, Rubin SC (2001) Cytoreductive surgery for ovarian cancer. Surg Clin North Am 81:871–883PubMedCrossRef

Bristow RE, Tomacruz RS, Armstrong DK, et al. (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259PubMedCrossRef

Griffiths CT (1975) Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr 42:101–104PubMed

Zang RY, Zhang ZY, Li ZT, et al. (2000) Effect of cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer. J Surg Oncol 75:24–30PubMedCrossRef

Glehen O KF, Sugarbaker PH, Elias D, et al. (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22:3284–3292PubMedCrossRef

Rose PG, Nerenstone S, Brady MF, et al. (2004) Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 351:2489–2497PubMedCrossRef

Panteix G, Beaujard A, Garbit F, et al. (2002) Population pharmacokinetics of cisplatin in patients with advanced ovarian cancer during intraperitoneal hyperthermia chemotherapy. Anticancer Res 22:1329–1336PubMed

Gilly FN, Carry PY, Sayag AC, et al. (1994) Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology 41:124–129PubMed

10.

Jacquet P, Sugarbaker PH (1996) Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res 82:359–374PubMed

11.

Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42PubMedCrossRef

12.

Glehen O, Mithieux F, Osinsky D, et al. (2003) Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study. J Clin Oncol 21:799–806PubMedCrossRef

13.

Markman M, Reichman B, Hakes T, et al. (1991) Responses to second-line cisplatin-based intraperitoneal therapy in ovarian cancer: influence of a prior response to intravenous cisplatin. J Clin Oncol 9:1801–1805PubMed

14.

Onda T, Yoshikawa H, Yasugi T, et al. (2005) Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. Br J Cancer 92:1026–1032PubMedCrossRef

15.

van der Vange N, van Goethem AR, Zoetmulder FA, et al. (2000) Extensive cytoreductive surgery combined with intra-operative intraperitoneal perfusion with cisplatin under hyperthermic conditions (OVHIPEC) in patients with recurrent ovarian cancer: a feasibility pilot. Eur J Surg Oncol 26:663–668PubMedCrossRef

16.

Glehen O, Beaujard AC, Arvieux C, et al. (2002) Les carcinoses péritonéales: traitement chirurgical, péritonectomie et chimiohyperthermie intrapéritonéale [Peritoneal carcinomatosis: surgical treatment, peritonectomy and intraperitoneal chemohyperthermia]. Gastroenterol Clin Biol 26:210–215PubMed

17.

Crile G Jr (1963) The effects of heat and radiation on cancers implanted on the feet of mice. Cancer Res 23:372–380PubMed

18.

Barlogie B, Corry PM, Drewinko B (1980) In vitro thermochemotherapy of human colon cancer cells with cis-dichlorodiammineplatinum (II) and mitomycin C. Cancer Res 40:1165–1168PubMed

19.

Glehen O, Mohamed F, Gilly FN (2004) Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol 5:219–228PubMedCrossRef

20.

Elias DM, Ouellet JF (2001) Intraperitoneal chemohyperthermia: rationale, technique, indications, and results. Surg Oncol Clin N Am 10:915–933, xiPubMed

21.

de Bree E, Romanos J, Michalakis J, et al. (2003) Intraoperative hyperthermic intraperitoneal chemotherapy with docetaxel as second-line treatment for peritoneal carcinomatosis of gynaecological origin. Anticancer Res 23:3019–3027PubMed

22.

Look M, Chang D, Sugarbaker PH (2003) Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int J Gynecol Cancer 13:764–770PubMedCrossRef

23.

Deraco M, Rossi CR, Pennacchioli E, et al. (2001) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion in the treatment of recurrent epithelial ovarian cancer: a phase II clinical study. Tumori 87:120–126PubMed

24.

Zanon C, Clara R, Chiappino I, et al. (2004) Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg 28:1040–1045PubMedCrossRef

25.

Piso P, Dahlke MH, Loss M, et al. (2004) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer. World J Surg Oncol 2:21PubMedCrossRef

26.

Plaisant N, Quenet F, Fabbro M, et al. (2004) Secondary debulking surgery and intraperitoneal chemotherapy in advanced or recurrent epithelial ovarian cancer. Gynecol Obstet Fertil 32:391–397PubMedCrossRef

27.

Vaccarello L, Rubin SC, Vlamis V, et al. (1995) Cytoreductive surgery in ovarian carcinoma patients with a documented previously complete surgical response. Gynecol Oncol 57:61–65PubMedCrossRef

28.

Cormio G, di Vagno G, Cazzolla A, et al. (1999) Surgical treatment of recurrent ovarian cancer: report of 21 cases and a review of the literature. Eur J Obstet Gynecol Reprod Biol 86:185–188PubMedCrossRef

29.

Gadducci A, Iacconi P, Cosio S, et al. (2000) Complete salvage surgical cytoreduction improves further survival of patients with late recurrent ovarian cancer. Gynecol Oncol 79:344–349PubMedCrossRef

30.

Eisenkop SM, Friedman RL, Spirtos NM (2000) The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 88:144–153PubMedCrossRef

31.

Scarabelli C, Gallo A, Carbone A (2001) Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecol Oncol 83:504–512PubMedCrossRef

32.

Tay EH, Grant PT, Gebski V, et al. (2002) Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol 99:1008–1013PubMedCrossRef

33.

Kusamura S, Younan R, Baratti D, et al. (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 106:1144–1153PubMedCrossRef

34.

Munkarah AR, Coleman RL (2004) Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecol Oncol 95:273–280PubMedCrossRef

35.

Barakat RR, Sabbatini P, Bhaskaran D, et al. (2002) Intraperitoneal chemotherapy for ovarian carcinoma: results of long-term follow-up. J Clin Oncol 20:694–698PubMedCrossRef

36.

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

Title: Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Chemoresistant and Recurrent Advanced Epithelial Ovarian Cancer: Prospective Study of 81 Patients
Authors: Eddy Cotte
Olivier Glehen
Faheez Mohamed
Franck Lamy
Claire Falandry
François Golfier
Francois Noel Gilly
Publication date: 01-09-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 9/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9146-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cytoreductive Surgery and Intraperitoneal Chemohyperthermia for Chemoresistant and Recurrent Advanced Epithelial Ovarian Cancer: Prospective Study of 81 Patients

Abstract

Purpose

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2007

Does Intraperitoneal Therapy Have a Role in Recurrent Ovarian Cancer?

A Simplified Technique for Translaryngeal Tracheostomy (TLT). A Preliminary Report

Liver Resection for Hepatocellular Carcinoma in a Hepatitis B Endemic Area

One-stage Correction of Rectovestibular Fistula by Transfistula Anorectoplasty (TFARP)

Modified Technique of Laparoscopic Intraperitoneal Hernioplasty for Irreducible Scrotal Hernias

Typhoid Intestinal Perforations: Twenty-six Year Experience