Intraoperative hyperthermic intraperitoneal chemotherapy after cytoreductive surgery in ovarian cancer peritoneal carcinomatosis: systematic review of current results
- First Online:
Advanced and recurrent ovarian cancer results in extensive spread of tumor on the peritoneal surfaces of the abdomen and pelvis. We collectively review studies in the literature that report the efficacy of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer peritoneal carcinomatosis.
An electronic search of all relevant studies published in peer-reviewed journals before May 2009 was performed on three databases. The quality of each study was independently assessed and classified according to the time point of HIPEC use in various setting of ovarian cancer from the consensus statement of the Peritoneal Surface Oncology Group. Clinical efficacy was synthesized through a narrative review with full tabulation of the results of each included study.
Nineteen studies each of more than ten patients reporting treatment results of HIPEC of patients with both advanced and recurrent ovarian cancer were included and data were extracted. All studies were observational case series. The overall rate of severe perioperative morbidity ranged from 0 to 40% and mortality rate varied from 0 to 10%. The overall median survival following treatment with HIPEC ranged from 22 to 64 months with a median disease-free survival ranging from 10 to 57 months. In patients with optimal cytoreduction, a 5-year survival rate ranging from 12 to 66% could be achieved.
Despite the heterogeneity of the studies reviewed, current evidence suggest that complete CRS and HIPEC may be a feasible option with potential benefits that are comparable with the current standard of care. A randomized trial is required to establish the role of HIPEC in ovarian cancer.
KeywordsOvarian cancer Peritoneal neoplasm Hyperthermia Cytoreductive surgery Intraperitoneal chemotherapy Hyperthermic intraperitoneal chemotherapy
- Bereder J, Glehen O, Habre J, Desantis M, Cotte E, Mounier N et al (2009) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from ovarian cancer: a multiinstitutional study of 246 patients. J Clin Oncol 27(15s):abstr 5542Google Scholar
- Chua TC, Liauw W, Robertson G, Chia WK, Soo KC, Alobaid A et al (2009a) Towards randomized trials of peritonectomy and hyperthermic intraperitoneal chemotherapy for ovarian cancer peritoneal carcinomatosis. Gynecol Oncol, EpubGoogle Scholar
- Chua TC, Yan TD, Saxena A, Morris DL (2009b) Should the treatment of peritoneal carcinomatosis by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy still be regarded as a highly morbid procedure? A systematic review of morbidity and mortality. Ann Surg, EpubGoogle Scholar
- Di Giorgio A, Naticchioni E, Biacchi D, Sibio S, Accarpio F, Rocco M et al (2008) Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer. Cancer 113(2):315–325PubMedCrossRefGoogle Scholar
- Jacquet P, Sugarbaker PH (1996) Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res 15:49–58Google Scholar
- Look M, Chang D, Sugarbaker PH (2004) Long-term results of cytoreductive surgery for advanced and recurrent epithelial ovarian cancers and papillary serous carcinoma of the peritoneum. Int J Gynecol Cancer 14:35–41Google Scholar
- Pavlov MJ, Kovacevic PA, Ceranic MS, Stamenkovic AB, Ivanovic AM, Kecmanovic DM (2009) Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer—12-year single center experience. Eur J Surg Oncol (in press)Google Scholar
- Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ et al (2006) Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol 24(29):4699–4707PubMedCrossRefGoogle Scholar
- Piso P, Dahlke MH, Loss M, Schlitt HJ (2004) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer. World J Surg Oncol 2(21)Google Scholar
- Raspagliesi F, Kusamura S, Campos Torres JC, de Souza GA, Ditto A, Zanaboni F et al (2006) 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 32(6):671–675PubMedCrossRefGoogle Scholar
- Rowan K (2009) Intraperitoneal therapy for ovarian cancer: why has it not become standard? J Natl Cancer Inst, EpubGoogle Scholar
- Sugarbaker PH (1996) Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology. In: Sugarbaker PH (ed) Peritoneal carcinomatosis: principles of management. Kluwer, BostonGoogle Scholar
- Vergote I, Tropé CG, Amant F, Kristensen GB, Sardi JE, Ehlen T et al (2008) EORTC-GCG/NCIC-CTG randomised trial comparing primary debulking surgery with neoadjuvant chemotherapy in stage IIIC–IV ovarian, fallopian tube and peritoneal cancer (OVCA). Paper presented at the 12th Biennial Meeting International Gynecologic Cancer Society—IGCS, Bangkok, ThailandGoogle Scholar
- Walker JL, Armstrong DK, Huang HQ, Fowler JM, Webster K, Burger RA et al (2006) Intraperitoneal catheter outcomes in a phase III trial of intravenous versus intraperitoneal chemotherapy in optimal stage III ovarian and primary peritoneal cancer: a Gynecologic Oncology Group study. J Clin Oncol 100:27–32Google Scholar