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Journal of Cancer Research and Clinical Oncology

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01-09-2014 | Original Article – Cancer Research

Different sequential approaches of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treating ovarian cancer with malignant ascites

Authors: Mingchen Ba, Hui Long, Xiangliang Zhang, Yunqiang Tang, Yinbing Wu, Feihong Yu, Shuai Wang, Shuzhong Cui

Published in: Journal of Cancer Research and Clinical Oncology | Issue 9/2014

Abstract

Background and objectives

Treatment for malignant ascites in advanced ovarian cancer (OC) patients remains controversial. The objective of this study was to investigate the efficacy of combined continuous circulatory hyperthermic intraperitoneal chemotherapy (HIPEC) preceded or followed by cytoreductive surgery (CRS) for malignant ascites in OC patients.

Methods

Female OC patients (n = 32) with malignant ascites were divided based on stable (n = 17) or unstable (n = 15) vital signs. Stable patients were treated with CRS immediately followed by HIPEC (CRS + HIPEC). Unstable patients were treated using B-mode ultrasound-guided HIPEC followed by delayed CRS upon vital sign stability (HIPEC + dCRS). All patients were followed up until death or until December 2012.

Results

Median follow-up was 29 months. All patients showed ascite regression [objective remission rates (ORR) = 100 %]. Among stable patients, CRS + HIPEC was successful in 14/17 (83.4 %). Among unstable patients, HIPEC + dCRS was successful in 13/15 (86.7 %). Median survival times were 19 and 17 months in the stable and unstable groups, respectively. No significant differences in CRS rates, ascites ORR, Karnofsky performance status scores, or survival rates were observed between groups (P > 0.05).

Conclusion

Cytoreductive surgery with immediate HIPEC and HIPEC with dCRS, determined by vital sign stability, may lead to similar outcomes in OC patients with malignant ascites.

Al-Shammaa HA, Li Y, Yonemura Y (2008) Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. World J Gastroenterol 14(8):1159–1166PubMedCentralPubMedCrossRef

Ba MC, Cui SZ, Lin SQ, Tang YQ, Wu YB, Wang B, Zhang XL (2010) Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites. World J Gastroenterol 16(15):1901–1907PubMedCentralPubMedCrossRef

Bakrin N, Cotte E, Golfier F, Gilly FN, Freyer G, Helm W, Glehen O, Bereder JM (2012) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for persistent and recurrent advanced ovarian carcinoma: a multicenter, prospective study of 246 patients. Ann Surg Oncol 19(13):4052–4058. doi:10.1245/s10434-012-2510-4 PubMedCrossRef

Baratti D, Kusamura S, Nonaka D, Langer M, Andreola S, Favaro M, Gavazzi C, Laterza B, Deraco M (2008) Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 15(2):526–534. doi:10.1245/s10434-007-9691-2 PubMedCrossRef

Baratti D, Kusamura S, Cabras AD, Dileo P, Laterza B, Deraco M (2009a) Diffuse malignant peritoneal mesothelioma: failure analysis following cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann Surg Oncol 16(2):463–472. doi:10.1245/s10434-008-0219-1 PubMedCrossRef

Baratti D, Kusamura S, Nonaka D, Cabras AD, Laterza B, Deraco M (2009b) Pseudomyxoma peritonei: biological features are the dominant prognostic determinants after complete cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann Surg 249(2):243–249. doi:10.1097/SLA.0b013e31818eec64 PubMedCrossRef

Becker G, Galandi D, Blum HE (2006) Malignant ascites: systematic review and guideline for treatment. Eur J Cancer 42(5):589–597. doi:10.1016/j.ejca.2005.11.018 PubMedCrossRef

Benoit L, Cheynel N, Ortega-Deballon P, Giacomo GD, Chauffert B, Rat P (2008) Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs. Ann Surg Oncol 15(2):542–546. doi:10.1245/s10434-007-9635-x PubMedCentralPubMedCrossRef

Carter JS, Downs LS Jr (2011) A prospective clinical trial of lenalidomide with topotecan in women with advanced epithelial ovarian carcinoma. Int J Clin Oncol 16(6):666–670. doi:10.1007/s10147-011-0243-1 PubMedCentralPubMed

Ceelen WP, Peeters M, Houtmeyers P, Breusegem C, De Somer F, Pattyn P (2008) Safety and efficacy of hyperthermic intraperitoneal chemoperfusion with high-dose oxaliplatin in patients with peritoneal carcinomatosis. Ann Surg Oncol 15(2):535–541. doi:10.1245/s10434-007-9648-5 PubMedCrossRef

Ceelen WP, Van Nieuwenhove Y, Van Belle S, Denys H, Pattyn P (2012) Cytoreduction and hyperthermic intraperitoneal chemoperfusion in women with heavily pretreated recurrent ovarian cancer. Ann Surg Oncol 19(7):2352–2359. doi:10.1245/s10434-009-0878-6 PubMedCrossRef

Cui S, Ba M, Tang Y, Liu J, Wu Y, Wang B, Zhang X, Tang H, Zhong S (2012) B ultrasound-guided hyperthermic intraperitoneal perfusion chemotherapy for the treatment of malignant ascites. Oncol Rep 28(4):1325–1331. doi:10.3892/or.2012.1913 PubMed

Deraco M, Casali P, Inglese MG, Baratti D, Pennacchioli E, Bertulli R, Kusamura S (2003) Peritoneal mesothelioma treated by induction chemotherapy, cytoreductive surgery, and intraperitoneal hyperthermic perfusion. J Surg Oncol 83(3):147–153. doi:10.1002/jso.10255 PubMedCrossRef

Di Giorgio A, Naticchioni E, Biacchi D, Sibio S, Accarpio F, Rocco M, Tarquini S, Di Seri M, Ciardi A, Montruccoli D, Sammartino P (2008) Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer 113(2):315–325. doi:10.1002/cncr.23553 PubMedCrossRef

Elias D, Lefevre JH, Chevalier J, Brouquet A, Marchal F, Classe JM, Ferron G, Guilloit JM, Meeus P, Goere D, Bonastre J (2009) Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin. J Clin Oncol 27(5):681–685. doi:10.1200/JCO.2008.19.7160 PubMedCrossRef

Engel J, Eckel R, Schubert-Fritschle G, Kerr J, Kuhn W, Diebold J, Kimmig R, Rehbock J, Holzel D (2002) Moderate progress for ovarian cancer in the last 20 years: prolongation of survival, but no improvement in the cure rate. Eur J Cancer 38(18):2435–2445PubMedCrossRef

Facchiano E, Scaringi S, Kianmanesh R, Sabate JM, Castel B, Flamant Y, Coffin B, Msika S (2008) Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of malignant ascites secondary to unresectable peritoneal carcinomatosis from advanced gastric cancer. Eur J Surg Oncol 34(2):154–158. doi:10.1016/j.ejso.2007.05.015 PubMedCrossRef

Ferron G, Gesson-Paute A, Classe JM, Querleu D (2005) Feasibility of laparoscopic peritonectomy followed by intra-peritoneal chemohyperthermia: an experimental study. Gynecol Oncol 99(2):358–361. doi:10.1016/j.ygyno.2005.06.043 PubMedCrossRef

Fujimoto S, Shrestha RD, Kokubun M, Ohta M, Takahashi M, Kobayashi K, Kiuchi S, Okui K, Miyoshi T, Arimizu N et al (1988) Intraperitoneal hyperthermic perfusion combined with surgery effective for gastric cancer patients with peritoneal seeding. Ann Surg 208(1):36–41PubMedCentralPubMedCrossRef

Garofalo A, Valle M, Garcia J, Sugarbaker PH (2006) Laparoscopic intraperitoneal hyperthermic chemotherapy for palliation of debilitating malignant ascites. Eur J Surg Oncol 32(6):682–685. doi:10.1016/j.ejso.2006.03.014 PubMedCrossRef

Gonzalez-Moreno S, Kusamura S, Baratti D, Deraco M (2008) Postoperative residual disease evaluation in the locoregional treatment of peritoneal surface malignancy. J Surg Oncol 98(4):237–241. doi:10.1002/jso.21072 PubMedCrossRef

Hagendoorn J, van Lammeren G, Boerma D, van der Beek E, Wiezer MJ, van Ramshorst B (2009) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival. Eur J Surg Oncol 35(8):833–837. doi:10.1016/j.ejso.2008.10.006 PubMedCrossRef

Helm CW, Bristow RE, Kusamura S, Baratti D, Deraco M (2008) Hyperthermic intraperitoneal chemotherapy with and without cytoreductive surgery for epithelial ovarian cancer. J Surg Oncol 98(4):283–290. doi:10.1002/jso.21083 PubMedCrossRef

Huh JW, Kim YJ, Kim HR (2009) Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis. World J Gastroenterol 15(6):756–757PubMedCentralPubMedCrossRef

Lavin PT, Knapp RC, Malkasian G, Whitney CW, Berek JC, Bast RC Jr (1987) CA 125 for the monitoring of ovarian carcinoma during primary therapy. Obstet Gynecol 69(2):223–227PubMed

McQuellon RP, Russell GB, Shen P, Stewart JHt, Saunders W, Levine EA (2008) Survival and health outcomes after cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of appendiceal origin. Ann Surg Oncol 15(1):125–133. doi:10.1245/s10434-007-9678-z PubMedCrossRef

Moran-Mendoza A, Alvarado-Luna G, Calderillo-Ruiz G, Serrano-Olvera A, Lopez-Graniel CM, Gallardo-Rincon D (2006) Elevated CA125 level associated with Meigs’ syndrome: case report and review of the literature. Int J Gynecol Cancer 16(Suppl 1):315–318. doi:10.1111/j.1525-1438.2006.00228.x PubMedCrossRef

Munene G, Francis W, Garland SN, Pelletier G, Mack LA, Bathe OF (2012) The quality of life trajectory of resected gastric cancer. J Surg Oncol 105(4):337–341. doi:10.1002/jso.22139 PubMedCrossRef

Parson EN, Lentz S, Russell G, Shen P, Levine EA, Stewart JHt (2011) Outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface dissemination from ovarian neoplasms. Am J Surg 202(4):481–486. doi:10.1016/j.amjsurg.2011.02.004 PubMedCrossRef

Roviello F, Marrelli D, Neri A, Cerretani D, de Manzoni G, Pedrazzani C, Cioppa T, Nastri G, Giorgi G, Pinto E (2006) Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity. World J Surg 30(11):2033–2040. doi:10.1007/s00268-006-0038-0 (discussion 2041–2032)PubMedCrossRef

Roviello F, Pinto E, Corso G, Pedrazzani C, Caruso S, Filippeschi M, Petrioli R, Marsili S, Mazzei MA, Marrelli D (2010) Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol 102(6):663–670. doi:10.1002/jso.21682 PubMedCrossRef

Scaringi S, Kianmanesh R, Sabate JM, Facchiano E, Jouet P, Coffin B, Parmentier G, Hay JM, Flamant Y, Msika S (2008) Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: a single western center experience. European J Surg Oncol 34(11):1246–1252. doi:10.1016/j.ejso.2007.12.003 CrossRef

Shido A, Ohmura S, Yamamoto K, Kobayashi T, Fujimura T, Yonemura Y (2000) Does hyperthermia induce peritoneal damage in continuous hyperthermic peritoneal perfusion? World J Surg 24(5):507–511PubMedCrossRef

Spratt JS, Adcock RA, Muskovin M, Sherrill W, McKeown J (1980a) Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 40(2):256–260PubMed

Spratt JS, Adcock RA, Sherrill W, Travathen S (1980b) Hyperthermic peritoneal perfusion system in canines. Cancer Res 40(2):253–255PubMed

Stuart GC, Kitchener H, Bacon M, duBois A, Friedlander M, Ledermann J, Marth C, Thigpen T, Trimble E, Participants of 4th Ovarian Cancer Consensus C, Gynecologic Cancer I (2011) 2010 Gynecologic Cancer InterGroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the Fourth Ovarian Cancer Consensus Conference. Int J Gynecol Cancer 21(4):750–755. doi:10.1097/IGC.0b013e31821b2568 PubMedCrossRef

Sugarbaker PH, Schellinx ME, Chang D, Koslowe P, von Meyerfeldt M (1996) Peritoneal carcinomatosis from adenocarcinoma of the colon. World J Surg 20(5):585–591 (discussion 592)PubMedCrossRef

Vergote IB, Bormer OP, Abeler VM (1987) Evaluation of serum CA 125 levels in the monitoring of ovarian cancer. Am J Obstet Gynecol 157(1):88–92PubMedCrossRef

Votanopoulos KI, Ihemelandu C, Shen P, Stewart JH, Russell GB, Levine EA (2012) Outcomes of repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for the treatment of peritoneal surface malignancy. J Am Coll Surg 215(3):412–417. doi:10.1016/j.jamcollsurg.2012.04.023 PubMedCentralPubMedCrossRef

Woopen H, Sehouli J (2009) Current and future options in the treatment of malignant ascites in ovarian cancer. Anticancer Res 29(8):3353–3359PubMed

Zanon C, Bortolini M, Chiappino I, Simone P, Bruno F, Gaglia P, Airoldi M, Deriu L, Mashiah A (2006) Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer. World J Surg 30(11):2025–2032. doi:10.1007/s00268-005-0486-y PubMedCrossRef

Title: Different sequential approaches of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treating ovarian cancer with malignant ascites
Authors: Mingchen Ba
Hui Long
Xiangliang Zhang
Yunqiang Tang
Yinbing Wu
Feihong Yu
Shuai Wang
Shuzhong Cui
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: Journal of Cancer Research and Clinical Oncology / Issue 9/2014
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-014-1692-5

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