CYTOREDUCTIVE SURGERY IN THE TREATMENT OF ADVANCED OVARIAN CANCER: A COMPARATIVE ANALYSIS OF THE RESULTS

The first experience of cytoreductive surgery technology and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) usage in the practice of Irkutsk Regional Cancer Center. All subjects were divided into 2 groups: the group of clinical comparison - the patients after suboptimal cytoreduction (53 persons), and the main group - the patients after optimal or complete debulking operation and hyperthermic intraperitoneal chemotherapy in some cases (32 persons). The subjects had ovarian cancer. The indispensable prerequisite of picking was confirmed carcinomatous peritoneal spread, resectable process, overall status. The primary analysis assay included time factors such as preoperation period, operation time, postoperative bed-days, in plus, complications and their character in postoperative period. In the article there are statistics of disease-free and overall survival in all groups and full consistent outline of the intraoperative hyperthermic chemotherapy method. The research has prospective character, observation continued. Expected results will be significant difference of disease-free and overall survival in the groups of interest.

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A Novel Non-Invasive Epithelial Ovarian Cancer Mouse Model Of Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

10.1101/2021.05.16.444343 ◽

2021 ◽

Author(s):

Zahraa Alali ◽

Max P. Horowitz ◽

Danielle Chau ◽

Lexie Trestan ◽

Jing Hao ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Mouse Model ◽

Tumor Growth ◽

Epithelial Ovarian Cancer ◽

Intraperitoneal Chemotherapy ◽

Murine Model ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Advanced Ovarian Cancer

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with interval cytoreductive surgery increases the overall survival of epithelial ovarian cancer (EOC) patients with advanced disease. Despite its proven benefits, the mechanism by which HIPEC extends overall survival remains unknown and current strategies to optimize HIPEC are therefore limited. A major challenge is the lack of a robust and streamlined model to investigate the mechanisms underlying HIPEC efficacy. Objective: To introduce a novel murine model that can be used to enhance our understanding of HIPEC therapy. Method: ID8-luc, an EOC mouse cell line, is inoculated into immunocompetent C57BL/6J mice intraperitoneally. Once tumor is detected by In Vivo Imaging System (IVIS), cisplatin (5 mg/kg) is injected intraperitoneally and superficial hyperthermia of 40C is applied to the animals abdomen and pelvis using an FDA-approved hyperthermia unit (BSD500) for 20 minutes. To validate the model, four treatment conditions were tested: cisplatin and hyperthermia, cisplatin and normothermia, vehicle and hyperthermia, and vehicle and normothermia. Tumor growth was assessed over the course of treatment using IVIS optical spectrum. Results: Tumor growth in mice treated with hyperthermic cisplatin was significantly suppressed compared to mice treated with normothermic cisplatin (p < 0.05). No significant differences in tumor growth were observed in the hyperthermic vehicle and normothermic vehicle groups. Conclusions: We developed an innovative noninvasive mouse model of HIPEC. Similar to patients with advanced ovarian cancer who are treated with HIPEC at the time of interval cytoreductive surgery, our model demonstrates that hyperthermia enhances the inhibitory effect of cisplatin on intraperitoneal tumor growth. Development of this murine model provides an opportunity to elucidate the mechanisms underlying HIPEC and offer an opportunity to test adjunct treatments in a pre-clinical setting to enhance the utility of HIPEC.

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Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer with peritoneal metastasis: a prospective registry study on 41 patients

Pleura and Peritoneum ◽

10.1515/pp-2017-0021 ◽

2017 ◽

Vol 2 (4) ◽

pp. 171-179

Author(s):

Melissa Ching Ching Teo ◽

Claramae Shulyn Chia ◽

Cindy Lim ◽

Grace Hwei Ching Tan ◽

Whay Kuang Chia ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Recurrent Ovarian Cancer ◽

Peritoneal Metastases ◽

High Grade ◽

Crs And Hipec ◽

Disease Free

AbstractBackgroundCytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases from ovarian cancer have been shown to have a role in recurrent ovarian cancer, but are still not considered standard therapy.MethodsFrom March 2005 to July 2013, 41 patients who underwent 44 CRS and HIPEC for peritoneal metastases in recurrent ovarian cancer were included in this study. Details were obtained from a prospectively maintained database. Our aim was to report our 5-year overall and disease-free survivals, as well as prognostic factors for survival.ResultsMedian age was 50 years old (range 23–73). Median duration of surgery was 510 min (range 230–840) and median peritoneal carcinomatosis index (PCI) score was 9.5 (range 0–31). About 92.7% of the patients had completeness of cytoreduction (CC) scores of 0 or 1. Median follow-up was 43.9 months (range 0.7–108.9). There were no mortalities and the high-grade morbidity rate was 31.8%. Median overall survival was 42.8 months (range 28.6–99.9) 5-year overall and disease-free survivals were 49.3% and 7.5% respectively. On multivariate analysis, histology and CC score were significantly associated with overall survival while histology and disease-free interval were associated with disease-free survival. The odds of developing a high-grade complication more than doubled for each additional surgical procedure performed (p=0.01).ConclusionsCRS and HIPEC can attain prolonged survival in selected patients with peritoneal metastasis in recurrent ovarian cancer.

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Primary cytoreductive surgery with or without Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for FIGO stage III epithelial ovarian cancer: The OVHIPEC-2 trial in progress.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.tps6100 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. TPS6100-TPS6100

Author(s):

Ruby M. van Stein ◽

Simone N. Koole ◽

Karolina Sikorska ◽

Desmond P. Barton ◽

Lewis Perrin ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Figo Stage ◽

Phase Iii ◽

Stage Iii ◽

Peritoneal Cancer ◽

Anticancer Treatment

TPS6100 Background: The addition of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to interval cytoreductive surgery improves recurrence-free and overall survival in patients with FIGO stage III ovarian cancer who are ineligible for primary cytoreductive surgery due to extensive intraperitoneal disease. The effect of HIPEC remains undetermined in patients who are eligible for primary cytoreductive surgery. We hypothesize that the addition of HIPEC to a complete or near-complete (residual disease ≤2.5 mm) primary cytoreductive surgery improves overall survival in patients with FIGO stage III ovarian cancer. Methods: This international, randomized, open-label, phase III trial enrolls patients with newly diagnosed, histological proven FIGO stage III epithelial ovarian, fallopian tube, or primary peritoneal cancer. Patients with resectable umbilical, spleen or local bowel lesions may be included. Following complete or near-complete primary cytoreduction, patients are intra-operatively randomized (1:1) to receive HIPEC or no HIPEC. Patients in both study arms will receive six courses of adjuvant carboplatin-paclitaxel and maintenance PARP-inhibitor or bevacizumab according to current guidelines. The primary endpoint is overall survival. To detect a Hazard Ratio of 0.67 in favor of HIPEC, 200 overall survival events are required. Assuming that accrual will be completed in 60 months, and 12 months additional follow-up, 538 patients need to be randomized. All randomized patients will be included in the analysis for overall survival according to the intention to treat principle. Pre-specified subgroup analyses will be performed based on stratification factors (peritoneal cancer index at start of surgery, completeness of surgery), histologic subtype (high-grade serous versus other), and BRCA mutation (BRCA1/2 mutation versus wildtype). Secondary endpoints are recurrence-free survival, time to first subsequent anticancer treatment, and treatment related complications and toxicity. Exploratory endpoints are time to second subsequent anticancer treatment, health-related quality of life, and cost-effectiveness. The Institutional Review Board of the Netherlands Cancer Institute approved the trial, which is actively enrolling patients since January 2020. Clinical trial information: NCT03772028.

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Neoadjuvant chemotherapy followed by fast-track cytoreductive surgery plus short-course hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: preliminary results of a promising all-in-one approach

Cancer Management and Research ◽

10.2147/cmar.s153327 ◽

2017 ◽

Vol Volume 9 ◽

pp. 869-878 ◽

Cited By ~ 4

Author(s):

Thales Paulo Batista ◽

Vandré Carneiro ◽

Rodrigo Tancredi ◽

Ana Ligia Teles ◽

Levon Badiglian-Filho ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Fast Track ◽

Advanced Ovarian Cancer ◽

Preliminary Results ◽

Short Course

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RESULTS OF HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY AND CYTOREDUCTIVE SURGERY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN

British Journal of Surgery ◽

10.1093/bjs/znab160.064 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Merayo Alvarez ◽

E Turienzo Santos ◽

M García Munar ◽

I Cifrián Canales ◽

J L Rodicio Miravalles ◽

...

Keyword(s):

Overall Survival ◽

Peritoneal Carcinomatosis ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Descriptive Analysis ◽

Disease Free Interval ◽

Free Interval ◽

Colorectal Origin ◽

Disease Free

Abstract INTRODUCTION Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is supported by clinical practice and published series as a fundamental treatment for increasing survival of selected patients with colorectal peritoneal carcinomatosis. The results were evaluated since having implemented a peritoneal oncological surgery program five years ago. MATERIAL AND METHODS Descriptive analysis was conducted to patients who had been diagnosed with peritoneal carcinomatosis from May 2014 to December 2020. 36 out of 100 patients who had undergone surgery were included in the CRS and HIPEC assessment and 6 patients without HIPEC, were excluded. RESULTS The mean preoperative PCI was 7.81±6.61 accomplishing complete cytoreduction CC 0-CC-1 in the 36 cases. An average of 1.86±1.22 peritonectomies were performed. Among procedures, complete pelviperitonectomy (11 patients) and liver metastasis resection (6 patients) should be noticed. Complications were presented in 16 patients (8 patients over Clavien Dindo>III) and 6 required reinterventions due to hematoma (2) or anastomotic leak (2) mostly. The 4-year overall survival is 76.2% and the disease-free interval is 34 months within an average follow-up of 23 months. CONCLUSIONS The overall survival and disease-free interval rates are above the standards. Currently, peritoneal carcinomatosis might be considered a curative disease. The multidisciplinary assessment allows selecting patients who will benefit from surgery.

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Cytoreductive surgery and HIPEC (hyperthermic intraperitoneal chemotherapy) in combined treatment of ovarian cancer: time for the beginning of personalized therapy?

Current Issues in Pharmacy and Medical Sciences ◽

10.2478/cipms-2019-0028 ◽

2019 ◽

Vol 32 (3) ◽

pp. 154-159

Author(s):

Roman Yarema ◽

Nataliya Volodko ◽

Taras Fetsych ◽

Myron Оhorchak ◽

Orest Petronchak ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Median Overall Survival ◽

Type I ◽

Morphological Heterogeneity ◽

Brca 1

Abstract Background and objectives. During the two past decades, a new therapeutic approach to ovarian cancer (OC) has been developed. This combines cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, almost no data exist regarding the utility of biomarkers of morphological heterogeneity as prognostic factors in such patients. Methods. A retrospective study of the effectiveness of CRS and HIPEC was carried out in 59 patients with ovarian cancer. Biomarkers of morphological heterogeneity of OC were studied as prognostic factors: OC pathogenic types (based on the identification of р53 mutated gene protein expression) and homologous recombination deficit (basing on the identification of BRCA 1 gene expression status). Results. The survival of patients reliably differed with the division into two pathogenetic OC types established by immunohistochemistry: the median disease-free survival of type I OC patients was 14±1.7 months, type ІІ – 8±1.6 months (р = 0.007); the median overall survival of type I OC patients was 23.5±6.7 months, type ІІ – 12±1.9 months (р = 0.017). The median overall survival of patients with the somatic mutation of BRCA 1 gene and complete cytoreduction was 22±4.8 months, and without the somatic mutation of BRCA 1 gene – 12±3.3 months (р = 0.047). Conclusions. These data demonstrate that identification of the pathogenetic type of OC and BRCA 1 status may be useful for the personalized therapy of ovarian cancer patients treated with CRS/HIPEC.

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Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy Improves Survival with Acceptable Safety for Advanced Ovarian Cancer: A Clinical Study of 100 Patients

BioMed Research International ◽

10.1155/2021/5533134 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Jue Zhang ◽

Xin-bao Li ◽

Zhong-he Ji ◽

Ru Ma ◽

Wen-pei Bai ◽

...

Keyword(s):

Ovarian Cancer ◽

Surgical Treatment ◽

Intraperitoneal Chemotherapy ◽

Cytoreductive Surgery ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Peritoneal Cancer Index ◽

Karnofsky Performance Status ◽

Univariate Analysis ◽

Advanced Ovarian Cancer ◽

First Line

Background. The mainstay of treatment for advanced ovarian cancer is debulking surgery followed by chemotherapy that includes carboplatin and paclitaxel, but the prognosis is poor. This study is aimed at evaluating the efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) as first-line surgical treatment in patients with advanced ovarian cancer (AOC). Methods. FIGO stage III/IV AOC patients underwent CRS+HIPEC as first-line surgical treatment at our center from December 2007 to January 2020. The primary endpoint was survival, and the secondary endpoint was safety. Results. Among 100 patients, the median Karnofsky performance status (KPS) score was 80 (50-100), median peritoneal cancer index (PCI) was 19 (1-39), median completeness of cytoreduction (CC) score was 1 (0-3), number of organ regions removed was 4 (3-9), number of peritoneal regions removed was 4 (1-9), and number of anastomoses was 1 (0-4). The median follow-up was 36.8 months; 75 (75.0%) patients were still alive, and 25 (25.0%) had died. The median overall survival (mOS) was 87.6 (95% CI: 72.1-103.0) months, and the 1-, 2-, 3-, 4-, and 5-year survival rates were 94.1%, 77.2%, 68.2%, 64.2%, and 64.2%, respectively. Univariate analysis showed that better mOS correlated with an age ≤, KPS ≥ 80 , ascites ≤ 1000 ml, PCI < 19 , and CC score 0-1. Multivariate Cox analysis showed that CC was an independent factor for OS; patients who underwent CRS with a CC score 0-1 had a mPFS of 67.8 (95% CI: 48.3-87.4) months. The perioperative serious adverse event and morbidity rates were 4.0% and 2.0%, respectively. Conclusions. CRS+HIPEC improves survival for AOC patients with acceptable safety at experienced high-volume centers. Stringent patient selection and complete CRS are key factors for better survival.

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