Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Carcinoma: Analysis of 30-Day Morbidity and Mortality
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The aim of this study was to evaluate morbidity and mortality associated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with ovarian, fallopian tube, and primary peritoneal cancer.
A retrospective review of patients undergoing cytoreductive surgery plus HIPEC from 1 January 2007 to 29 July 2013 at two academic medical centers was performed. Grade 3/4 complications (National Cancer Institute’s Common Toxicity Criteria version 4.0) from day of surgery until 30 days postoperatively were recorded.
Thirty-two patients were identified, with 27 cases of ovarian cancer, three primary peritoneal cancers, and two fallopian tube cancers. Indications included 24 at the time of cancer recurrence, six at interval surgical resection, and two in the consolidative setting. Hyperthermic chemotherapeutic regimens included carboplatin (n = 21), cisplatin (n = 4), oxaliplatin (n = 2), oxaliplatin + intravenous 5-fluorouracil (n = 1), doxorubicin (n = 1), and cisplatin + doxorubicin (n = 1). Infusion time ranged from 30 to 90 min, with a maximum temperature range of 41–43 °C. The combined grade 3/4 morbidity rate was 65.6 %, and the most frequent morbidities included grade 3 anemia (40.6 %), infection (15.6 %), and pleural effusion (12.5 %). Six patients required readmission (18.8 %), and two patients required reoperation (6.2 %). Full-thickness diaphragm resection/peritoneal stripping had a significant association with grade 3/4 pleural effusions (p = 0.0007).
Cytoreductive surgery plus HIPEC is feasible in patients with ovarian cancer with 65.6 % grade 3/4 morbidity and no deaths. Balancing these complications with potential survival benefits is important in centers considering implementing HIPEC protocols.
- Siegel, R, Naishadham, D, Jemal, A (2013) Cancer statistics, 2013. CA Cancer J Clin. 63: pp. 11-30 CrossRef
- Ozols, RF, Bundy, BN, Greer, BE (2003) Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol. 21: pp. 3194-3200 CrossRef
- Bristow, R, Tomacruz, R (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol. 20: pp. 1248-1259 CrossRef
- Eisenkop, S, Spirtos, N, Friedman, R (2003) Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study. Gynecol Oncol. 90: pp. 390-396 CrossRef
- Armstrong, D, Bundy, B, Wenzel, L (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 354: pp. 34-43 CrossRef
- Landrum, LM, Java, J, Mathews, CA (2013) Prognostic factors for stage III epithelial ovarian cancer treated with intraperitoneal chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol. 130: pp. 12-18 CrossRef
- Eskander, RN, Cripe, J, Bristow, RE (2014) Intraperitoneal chemotherapy from Armstrong to HIPEC: challenges and promise. Curr Treat Options Oncol. 15: pp. 27-40 CrossRef
- Christophi, C, Winkworth, A, Muralihdaran, V, Evans, P (1998) The treatment of malignancy by hyperthermia. Surg Oncol. 7: pp. 83-90 CrossRef
- Bijelic, L, Jonson, A, Sugarbaker, PH (2007) Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol. 18: pp. 1943-1950 CrossRef
- Vaart, PJ, Vange, N, Zoetmulder, FA (1998) Intraperitoneal cisplatin with regional hyperthermia in advanced ovarian cancer: pharmacokinetics and cisplatin ± DNA adduct formation in patients and ovarian cancer cell lines. Eur J Cancer. 34: pp. 148-154 CrossRef
- Sugarbaker, P (1995) Peritonectomy procedures. Ann Surg. 221: pp. 29-42 CrossRef
- Giorgio, A, Naticchioni, E, Biacchi, D (2008) Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer. 113: pp. 315-325 CrossRef
- Stephens, AD, Alderman, R, Chang, D (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol. 6: pp. 790-796 CrossRef
- Aletti GD, Dowdy SC, Podratz KC, Cliby WA. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obstet Gynecol. 2007;197(6):676.e1–7. doi:10.1016/j.ajog.2007.10.495.
- Bashir, S, Gerardi, MA, Giuntoli, RL, Montes, TPD, Bristow, RE (2010) Surgical technique of diaphragm full-thickness resection and trans-diaphragmatic decompression of pneumothorax during cytoreductive surgery for ovarian cancer. Gynecol Oncol. 119: pp. 255-258 CrossRef
- Spratt, JS, Adcock, RA, Muskovin, M, Sherrill, W, Mckeown, J (1980) Clinical delivery system for intraperitoneal hyperthermic chemotherapy clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res. 40: pp. 256-260
- Fagotti, A, Costantini, B, Petrillo, M (2012) 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. 127: pp. 502-505 CrossRef
- Deraco, M, Kusamura, S, Virzì, S (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol 122: pp. 215-220 CrossRef
- Cascales-Campos, PA, Gil, J, Gil, E (2014) Treatment of microscopic disease with hyperthermic intraoperative intraperitoneal chemotherapy after complete cytoreduction improves disease-free survival in patients with stage IIIC/IV ovarian cancer. Ann Surg Oncol. 21: pp. 2383-2389 CrossRef
- Mulier, S, Claes, J, Dierieck, V (2012) Survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) at the different time-points of treatment of ovarian cancer: review of evidence. Curr Pharm Des. 18: pp. 3793-3803 CrossRef
- Chua, T, Robertson, G, Liauw, W (2009) Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results. J Cancer Res Clin Oncol. 135: pp. 1637-1645 CrossRef
- Bakrin, N, Gilly, FN, Baratti, D (2013) Primary peritoneal serous carcinoma treated by cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. A multi-institutional study of 36 patients. Eur J Surg Oncol. 39: pp. 742-747 CrossRef
- Bakrin, N, Bereder, JM, Decullier, E (2013) 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. 39: pp. 1435-1443 CrossRef
- Bakrin, N, Cotte, E, Golfier, F (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: pp. 4052-4058 CrossRef
- Fagotti, A, Costantini, B, Vizzielli, G (2011) HIPEC in recurrent ovarian cancer patients: morbidity-related treatment and long-term analysis of clinical outcome. Gynecol Oncol. 122: pp. 221-225 CrossRef
- Ansaloni, L, Agnoletti, V, Amadori, A (2012) Evaluation of extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer. 22: pp. 778-785 CrossRef
- Königsrainer, I, Beckert, S, Becker, S (2011) Cytoreductive surgery and HIPEC in peritoneal recurrent ovarian cancer: experience and lessons learned. Langenbecks Arch Surg. 396: pp. 1077-1081 CrossRef
- ClinicalTrials.gov., a service of the US National Institutes of Health. https://clinicaltrials.gov/ct2/results?term=HIPEC%2C+ovarian+cancer&show_down=Y. Accessed 27 Jun 2014.
- Argenta, PA, Sueblinvong, T, Geller, MA (2013) Hyperthermic intraperitoneal chemotherapy with carboplatin for optimally-cytoreduced, recurrent, platinum-sensitive ovarian carcinoma: a pilot study. Gynecol Oncol. 129: pp. 81-85 CrossRef
- Deraco, M, Virzì, S, Iusco, D (2012) Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi-institutional study. BJOG. 119: pp. 800-809 CrossRef
- Carrabin N, Mithieux F, Meeus P. Hyperthermic intraperitoneal chemotherapy with oxaliplatin and without adjuvant chemotherapy in stage IIIC ovarian cancer. Bull Cancer. 2010;97:1–10. Available at: http://www.jle.com/e-docs/00/04/57/15/article.phtml. Accessed 27 Jul 2014.
- Roviello, F, Pinto, E, Corso, G (2010) Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol. 102: pp. 663-670 CrossRef
- Lentz, S, Miller, B, Kucera, G, Levine, E (2007) Intraperitoneal hyperthermic chemotherapy using carboplatin: a phase I analysis in ovarian carcinoma. Gynecol Oncol. 106: pp. 207-210 CrossRef
- Bae, JH, Lee, JM, Ryu, KS (2007) Treatment of ovarian cancer with paclitaxel- or carboplatin-based intraperitoneal hyperthermic chemotherapy during secondary surgery. Gynecol Oncol. 106: pp. 193-200 CrossRef
- Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Carcinoma: Analysis of 30-Day Morbidity and Mortality
Annals of Surgical Oncology
Volume 22, Issue 2 , pp 655-661
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- 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of California, Irvine Medical Center, Orange, CA, USA
- 2. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA