scholarly journals Hyperthermic intraperitoneal chemotherapy for women with granulosa cell tumors of the ovary: a systematic review of the literature

2016 ◽  
Vol 1 (1) ◽  
pp. 15-22
Author(s):  
Clemens B. Tempfer ◽  
Wiebke Solass ◽  
Askin Dogan ◽  
Lukas A. Hefler ◽  
Marc-André Reymond
Keyword(s):  
Granulosa Cell ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Treatment Options ◽  
Late Relapse ◽  
Cochrane Central Register ◽  
Effective Treatment Option ◽  
Management Options ◽  
Granulosa Cell Tumors ◽  
Crs And Hipec

AbstractBackground: Adult and juvenile granulosa cell tumors of the ovary are rare functional sex-cord-stromal ovarian neoplasms characterized by low malignant potential and late relapse. Evidence-based management options for primary and recurrent juvenile (JGCT) and adult (AGCT) granulosa cell tumors are limited and treatment options have not been standardized. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may be an option to treat these women effectively.Methods: Systematic literature review using PubMed and the Cochrane Central Register of Controlled Trials.Results: No reports of HIPEC among women with a first diagnosis of AGCT were identified. We identified 5 reports on the safety and therapeutic efficacy of CRS and HIPEC in 19 patients with recurrent AGCT and one patient with JGCT. The pooled rate of complete cytoreduction was 95 % (18/19) with 16 % (3/19) severe morbidity and no procedure-related mortality. The median time of follow-up was 30 (range, 3 to 72) months, during which 6/19 (31 %) patients experienced a recurrence and two patients (10 %) died of the disease.Conclusion: CRS and HIPEC are a safe and potentially effective treatment option for selected women with recurrent AGCT limited to the abdomen.

scholarly journals Cost Effectiveness of Interval Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Stage III Ovarian Cancer on the Basis of a Randomized Phase III Trial

2019 ◽  
Vol 37 (23) ◽  
pp. 2041-2050 ◽  
Author(s):  
Simone N. Koole ◽  
Christiaan van Lieshout ◽  
Willemien J. van Driel ◽  
Evi van Schagen ◽  
Karolina Sikorska ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Health Care ◽  
Cost Effectiveness ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Phase Iii ◽  
Stage Iii ◽  
Sensitivity Analyses ◽  
Crs And Hipec

PURPOSE In the randomized open-label phase III OVHIPEC trial, the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery (CRS) improved recurrence-free and overall survival in patients with stage III ovarian cancer. We studied the cost effectiveness of the addition of HIPEC to interval CRS in patients with ovarian cancer. PATIENTS AND METHODS We constructed a Markov health-state transition model to measure costs and clinical outcomes. Transition probabilities were derived from the OVHIPEC trial by fitting survival distributions. Incremental cost-effectiveness ratio (ICER), expressed as euros per quality-adjusted life-year (QALY), was calculated from a Dutch societal perspective, with a time horizon of 10 years. Univariable and probabilistic sensitivity analyses were conducted to evaluate the decision uncertainty. RESULTS Total health care costs were €70,046 (95% credibility interval [CrI], €64,016 to €76,661) for interval CRS compared with €85,791 (95% CrI, €78,766 to €93,935) for interval CRS plus HIPEC. The mean QALY in the interval CRS group was 2.12 (95% CrI, 1.66 to 2.64 QALYs) and 2.68 (95% CrI, 2.11 to 3.28 QALYs) in the interval CRS plus HIPEC group. The ICER amounted to €28,299/QALY. In univariable sensitivity analysis, the utility of recurrence-free survival and the number of days in the hospital affected the calculated ICER most. CONCLUSION On the basis of the trial data, treatment with interval CRS and HIPEC in patients with stage III ovarian cancer was accompanied by a substantial gain in QALYs. The ICER is below the willingness-to-pay threshold in the Netherlands, indicating interval CRS and HIPEC is cost effective for this patient population. These results lend additional support for reimbursing the costs of treating these patients with interval CRS and HIPEC in countries with comparable health care systems.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Peritoneal Carcinomatosis: Initial Experience in Oaxaca, Mexico

2012 ◽  
Vol 78 (9) ◽  
pp. 942-946 ◽  
Author(s):  
Rolando GarcÍA-Matus ◽  
Carlos Alberto HernÁNdez-HernÁNdez ◽  
Omar Leyva-GarcÍA ◽  
Sergio Vásquez-Ciriaco ◽  
Guillermo Flores-Ayala ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Recurrent Ovarian Cancer ◽  
Initial Experience ◽  
Peritoneal Cancer ◽  
Duration Of Surgery ◽  
Crs And Hipec

Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multi-modality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at “Hospital Regional de Alta Especialidad de Oaxaca,” Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

scholarly journals Uncommon indications for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

2017 ◽  
Vol 2 (3) ◽  
pp. 129-136 ◽  
Author(s):  
Francis Zheng Yi Yee ◽  
Grace Hwei Ching Tan ◽  
Claramae Shulyn Chia ◽  
Khee Chee Soo ◽  
Melissa Ching Ching Teo
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Peritoneal Cancer Index ◽  
Transitional Cell ◽  
Granulosa Cell Tumor ◽  
Peritoneal Metastases ◽  
Peritoneal Cancer ◽  
Crs And Hipec ◽  
Uncommon Tumor

AbstractBackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has changed treatment for selected patients with peritoneal metastases (PM) arising from appendiceal, colorectal, epithelial ovarian, primary peritoneal and gastric cancers. However, the results of CRS with HIPEC remain unclear in PM from other tumor histologies.MethodsWe report a series of 10 patients who underwent CRS and HIPEC between 2006 and 2015, for PM arising from uncommon tumor origins.ResultsTen patients with PM from uncommon tumor origins underwent CRS and HIPEC. Median age was 46.5 years. Two patients had ovarian Sertoli-Leydig cell tumors (SLCT) and two had small bowel adenocarcinomas. The other histologies included: ovarian transitional cell carcinoma, ovarian granulosa cell tumor, endometroid adenocarcinoma, endocervical adenocarcinoma, synovial sarcoma, and ovarian leiomyosarcoma. Median peritoneal cancer index was 9 (2–18) and complete cytoreduction was achieved for all patients. Median follow-up was 14 months (2–100), and median time to recurrence from CRS and HIPEC was 16.0 months by Kaplan–Meier estimate. Four patients remain alive and disease-free, five are alive with disease, and one had died with disease. Median survival was not reached.ConclusionsEight of ten patients with peritoneal metastases in the above rare indications survived 10 months or more after CRS and HIPEC. These encouraging results are a rationale for prospective clinical trials in these tumor histologies.

scholarly journals Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy—current perspectives

2016 ◽  
Vol 23 (3) ◽  
pp. 266 ◽  
Author(s):  
J. Spiliotis ◽  
E. Halkia ◽  
E. De Bree
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Abdominal Cavity ◽  
Gastrointestinal Surgery ◽  
Morbidity And Mortality ◽  
Peritoneal Surface Malignancy ◽  
Perioperative Morbidity ◽  
Cancer Management ◽  
Peritoneal Surface ◽  
Crs And Hipec

Peritoneal carcinomatosis (PTC) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although PTC is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has successfully been used as locoregional treatment for selected patients with PTC from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, HIPEC can also be used to prevent PTC in high-risk patients, and the first results of the “second-look” approach are promising. Patient selection—in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed—is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete CRS. The present review discusses the principles of CRS and HIPEC, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of CRS and HIPEC is an indispensable tool in the oncologist’s armamentarium.

scholarly journals Survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from gastric cancer: a systematic review

2016 ◽  
Vol 1 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Claramae Shulyn Chia ◽  
Ramakrishnan Ayloor Seshadri ◽  
Vahan Kepenekian ◽  
Delphine Vaudoyer ◽  
Guillaume Passot ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Peritoneal Carcinomatosis ◽  
Median Survival ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Current Evidence ◽  
Term Survival ◽  
Crs And Hipec

AbstractBackground: The current treatment of choice for peritoneal carcinomatosis from gastric cancer is systemic chemotherapy. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a new aggressive form of loco-regional treatment that is currently being used in pseudomyxoma peritoneii, peritoneal mesothelioma and peritoneal carcinomatosis from colorectal cancer. It is still under investigation for its use in gastric cancer.Methods: The literature between 1970 and 2016 was surveyed systematically through a review of published studies on the treatment outcomes of CRS and HIPEC for peritoneal carcinomatosis from gastric cancer.Results: Seventeen studies were included in this review. The median survival for all patients ranged from 6.6 to 15.8 months. The 5-years overall survival ranged from 6 to 31%. For patients with complete cytoreduction, the median survival was 11.2 to 43.4 months and the 5-years overall survival was 13 % to 23%. Important prognostic factors were found to be a low peritoneal carcarcinomatosis index (PCI) score and the completeness of cytoreduction.Conclusion: The current evidence suggests that CRS and HIPEC has a role to play in the treatment of peritoneal carcinomatosis from gastric cancer. Long term survival has been shown for a select group of patients. However, further studies are needed to validate these results.

Peritoneal metastases of colorectal origin – cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The financial aspect

2017 ◽  
Vol 89 (6) ◽  
pp. 1-6
Author(s):  
Tomasz Jastrzębski ◽  
Marek Bębenek
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Distant Metastases ◽  
Peritoneal Metastases ◽  
Medical Procedures ◽  
Financial Loss ◽  
Colorectal Origin ◽  
Crs And Hipec ◽  
Financial Aspect

About 10% to 15% of patients with colon cancer have intraperitoneal metastases at diagnosis. The patients with intraperitoneal metastases and without distant metastases can benefit from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Because up to a half of patients live for at least 5 years after this treatment, the treatment is used more and more often. The treatment of patients with intraperitoneal metastases with CRS and HIPEC costs more than the majority of other medical procedures, because CRS is extensive and takes a lot of time, and after surgery, patients need intensive care and expensive medications and equipment. Currently, only 40% to 80% of costs of CRS and HIPEC are reimbursed in Poland. Because CRS and HIPEC mean a financial loss to hospitals, they are rarely performed. We analyzed the costs of treating patients with peritoneal metastases by CRS and HIPEC in two centers (Gdank, Wroclaw) and showed how this treatment is reimbursed outside Poland. We discussed whether adequate qualification of patients and experience of the teams giving the treatment could reduce the costs.

scholarly journals Short-Term Quality of Life Outcomes Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 232s-232s
Author(s):  
C. Koh ◽  
J. Young
Keyword(s):  
Quality Of Life ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Short Form ◽  
Staging System ◽  
Short Term ◽  
Extensive Disease ◽  
Crs And Hipec

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment of peritoneal malignancies (PM). However, it can also adversely affect patients' quality of life (QoL). Aim: This study reports short-term QoL outcomes following CRS and HIPEC and compares the QoL trajectories between patients with more extensive cancer to those with less extensive disease. Methods: Patients undergoing CRS and HIPEC at a single referral center between April 2017 and April 2018 were prospectively recruited. QoL was measured using short-form 36 version 2. Physical (PCS) and mental component scores (MCS) were scored according to the manual (higher scores reflect better QoL). Data were collected at baseline, predischarge, 3 and 6 months postoperatively. PCS and MCS trajectories were described. Results: Of 68 patients, 62 (91%) entered the study. Median PCS decreased from baseline to predischarge but this then recovers and improves beyond baseline by 3 months (43.4 IQR 35.2-55.2, 34.3 IQR 27.3-43.5, 48.1 IQR 37.6-52.5). Median MCS declined marginally postoperatively but improves above baseline by 3 months and continues to improve at 6 months (49.6 IQR 43.5-55.7, 47.8 IQR 39.9-55.0, 51.2 IQR 43.7-57.3, 56.2 IQR 42.8-58.6). Using a PCI (peritoneal carcinoma index, a staging system for the extent of disease from 0-39, higher value denotes more extensive disease) ≥ 15, patients with high PCI were found to have worse PCS at baseline (36.5 vs 48.9, P < 0.005). Despite nonstatistically significant differences in MCS between high PCI and low PCI patients, there is a clinically significant trend among patients with high PCI in that the trajectory for MCS is one of continued decline. Conclusion: Short-term QoL after CRS and HIPEC is acceptable. QoL returned to baseline quicker than anticipated. Further studies are needed to describe the long-term QoL and in particular, the relationship between PCI and QoL needs further evaluation.

scholarly journals Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei of Appendiceal Origin: A Single Center Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Francesco Santullo ◽  
Fabio Pacelli ◽  
Carlo Abatini ◽  
Miriam Attalla El Halabieh ◽  
Giusy Fortunato ◽  
...  
Keyword(s):  
Survival Rate ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Pseudomyxoma Peritonei ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Crs And Hipec ◽  
The Mean ◽  
Incomplete Cytoreduction

Background: Pseudomyxoma peritonei (PMP) originating from appendiceal mucinous neoplasm is a rare peritoneal malignancy characterized by the progressive intraperitoneal accumulation of mucus leading to death if left untreated. In recent years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) offered increased survival rates. This study aims to identify the clinical, pathological, and surgical features influencing safety and survival outcomes of patients undergoing CRS and HIPEC for PMP of appendiceal origin.Methods: A retrospective analysis of all patients undergoing CRS and HIPEC for PMP of appendiceal origin from January 2015 to May 2019 was conducted at our institution.Results: Study population included 50 patients (74% female, 26% male). The median age at CRS was 60 (38–84). The median peritoneal cancer index (PCI) was 17. Complete cytoreductive surgery (CC 0–1) was achieved in 47 patients (94%). HIPEC chemotherapeutic regimen was based on oxaliplatin for 13 (28%) patients and mitomycin for 34 (72%) patients. We experienced a total of 19 (38%) postoperative complications, of which 14 (74%) of grade I-II and 5 (26%) of grade III-IV, according to the Clavien-Dindo classification. The median follow-up period was 27 months (12–107) from the date of cytoreductive surgery. The mean survival rate was 100 months, with a 5-year OS of 91%. The mean progression-free survival rate was 77 months (0–107), with a 5-year PFS of 63%. Multivariate analysis identified adenocarcinoma histotype and incomplete cytoreduction to significantly worsen progression-free survival, while incomplete cytoreduction was the only independent predictor of poorer overall survival.Conclusion: Complete cytoreduction and appendiceal neoplasm histotype play a crucial role in the survival of patients affected by PMP of appendiceal origin. The rates of morbidity associated with CRS and HIPEC for PMP are acceptable.

Female sex and standardized mitomycin-c dose are associated with increased risk of neutropenia after hyperthermic intraperitoneal chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15091-15091
Author(s):  
L. A. Lambert ◽  
T. S. Armstrong ◽  
J. J. Lee ◽  
M. H. Katz ◽  
C. Eng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Mitomycin C ◽  
Intraperitoneal Chemotherapy ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Female Sex ◽  
Complication Risk ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Crs And Hipec

15091 Background: Cytoreductive sugery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are being increasingly employed in the managment of peritoneal-based malignancies. Depending on the treatment regimen, neutropenia (NP) is a common and potentially life-threatening early postoperative complication of HIPEC. However, little is known about the incidence or risk factors associated with HIPEC-induced NP. Methods: From January 1993 to October 2006, 120 CRS and HIPEC with mitomycin-c (MMC) were performed in 117 patients with appendiceal neoplasm. NP was defined as an absolute neutrophil count of < 1,000/mm3. Variables assessed as potential risk factors for HIPEC-induced NP included: age, sex, weight, BMI, BSA, splenectomy, dose of MMC (standardized for BSA and nonstandardized), percent of perfusate recovered, length of surgery, estimated blood loss, perioperative blood transfusion, and history of prior chemotherapy. Results: Total perfusate MMC doses ranged between 37.25 and 65 mg. The overall incidence of NP was 39.2%. The NP rates in female and male were 57.6% and 21.3%, respectively. Female sex, BMI, BSA, and the standardized dose of MMC were significantly associated with an increased risk of NP by univariable logistic regression. Female sex and standardized dose of MMC remained statistically significant for an increased risk of NP on multivariable logistic regression. The odds ratio (OR) of NP for females was 3.63 (95% CI: 1.54, 8.52); the OR of NP for a 1 mg/m2 increase in standardized MMC dose was 1.26 (95% CI: 1.11, 1.44). No other variables were identified as independent predictors of increased or decreased risk of NP. Compared to patients without NP, patients with NP had a higher rate of urinary tract infection (42.6% vs. 21.1%, p=0.01) and slightly higher length of stay (median: 24.0 days vs. 18.5 days, p=0.16). Conclusions: NP is a common complication after HIPEC with MMC . Female patients are at significantly increased risk for this complication. Risk of NP also increases with MMC dose standardized for BSA. With increasing interest in the use of CRS and HIPEC, understanding the risk factors for HIPEC-induced NP may facilitate reducing the morbidity associated with this procedure. No significant financial relationships to disclose.

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