Hyperthermic intraperitoneal chemotherapy in conjunction with surgery for the treatment of recurrent ovarian carcinoma.
OBJECTIVE
To review experience of secondary surgical cytoreduction (SSC) with hyperthermic intraperitoneal chemotherapy (IPHC).


METHODS
Eligible patients with ovarian cancer in whom pre-operative evaluation indicated that there was a good possibility that disease could be resected to < or = 5 mm underwent surgery followed by intraperitoneal perfusion of cisplatin (100 mg/m2) or mitomycin C (30-40 mg total dose) heated to 41-43 degrees C (105.8-109.4 degrees F) for 90 min. Data for analysis were extracted from retrospective chart review.


RESULTS
Eighteen patients underwent surgery and IPHC between 9/02 and 3/05. Characteristics were median age 64 (37-77) years, mean prior laparotomies 1.4 (0-3), mean chemotherapy regimens 3.2 (0-7), mean time from initial therapy to IPHC 30.6 (1-88) months. Original histology: papillary serous 12, poorly differentiated adenocarcinoma 1, serous low malignant potential 2, mucinous 1 and mixed subtypes 2. 13 had recurrent disease and 5 had persistent disease following front-line therapy. 15 received cisplatin and 3 mitomycin C. The mean duration of surgery was 9.8 (5-16) h. The maximum dimension of residual lesions at the end of surgery prior to IPHC was nil (n=11), < or = 2 mm (n=4), < or = 5 mm (n=2) and < or = 10 mm (n=1). Mean time to return of bowel function was 7 (5-20) days and mean time to hospital discharge 11.5 (5-49) days. All patients developed CTEP grade 1 or 2 metabolic or hematologic toxicities. CTEP grade 3 or 4 metabolic toxicity occurred in 72% and a hematologic toxicity in 28%. There was one peri-operative death due to pulmonary embolus. Median progression-free interval was 10 months and median overall survival was 31 months. Improved outcome was significantly related to the size of residual disease prior to IPHC and postoperative chemotherapy.


CONCLUSIONS
IPHC is a relatively well-tolerated procedure with the majority of the morbidity being related to associated surgery. When combined with SSC it has the potential to extend quality life in some patients with recurrent ovarian cancer and warrants continued research. Randomized studies are needed earlier in the course of the disease.
Helm
C William
CW
Division of Gynecologic Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY 40202, USA. cwhelm@uoflobgyn.com
Randall-Whitis
Leslie
L
Martin
Robert S
RS
Metzinger
Daniel S
DS
Gordinier
Mary E
ME
Parker
Lynn P
LP
Edwards
Robert P
RP
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007263:Infusions, Parenteral; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D016685:Mitomycin; D002945:Cisplatin