Cytoreductive surgery and intraperitoneal chemo-hyperthermia for chemo-resistant and recurrent advanced epithelial ovarian cancer: prospective study of 81 patients.
OBJECTIVE
There is no standardized treatment for patients with chemo-resistant or recurrent advanced ovarian cancer. Locoregional treatments combining cytoreductive surgery and intraperitoneal chemohyperthermia (HIPEC) may improve survival for locoregional disease.


METHODS
A prospective single center study of 81 patients with recurrent or chemo-resistant peritoneal carcinomatosis from ovarian cancer was performed. Patients were treated by maximal cytoreductive surgery combined with HIPEC (with cisplatinum at 20 mg/m(2)/L). A total of 47 patients were included for their third, fourth, fifth, sixth, or seventh surgical look. Altogether, 54 patients presented with extensive carcinomatosis (malignant nodules of >5 mm).


RESULTS
Complete macroscopic resection (CCR-0) was achieved in 45 patients. Mortality and morbidity rates were 2.5% and 13.6%, respectively. With a median follow-up of 47.1 months, the overall and disease-free median survivals were 28.4 and 19.2 months, respectively. Carcinomatosis extent and completeness of cytoreduction (p = 0.02 and p <0.001, respectively) were identified as independent prognostic factors. For CCR-0 patients, overall and disease-free survivals were 54.9 and 26.9 months, respectively.


CONCLUSIONS
Salvage therapy combining optimal cytoreductive surgery and HIPEC may achieve long-term survival in selected patients with recurrent or chemo-resistant ovarian cancer. This strategy may be most effective in patients with limited carcinomatosis or when cytoreductive surgery provides sufficient downstaging.
Cotte
Eddy
E
Department of Oncologic Surgery, Centre Hospitalo-Universitaire Lyon Sud, 69495, Pierre Bénite, Cedex, France.|EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France.
Glehen
Olivier
O
Department of Oncologic Surgery, Centre Hospitalo-Universitaire Lyon Sud, 69495, Pierre Bénite, Cedex, France. olivier.glehen@chu-lyon.fr.|EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France. olivier.glehen@chu-lyon.fr.
Mohamed
Faheez
F
School of Surgical and Reproductive Sciences, Newcastle upon Tyne, UK.
Lamy
Franck
F
Department of Oncologic Surgery, Centre Hospitalo-Universitaire Lyon Sud, 69495, Pierre Bénite, Cedex, France.|EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France.
Falandry
Claire
C
EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France.|Department of Medical Oncology, CHLS-HCL, 69495, Pierre Bénite, Cedex, France.
Golfier
François
F
EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France.|Department of Gynecologic surgery, Centre Hospitalo-Universitaire Lyon Sud, 69495, Pierre Bénite, Cedex, France.
Gilly
Francois Noel
FN
Department of Oncologic Surgery, Centre Hospitalo-Universitaire Lyon Sud, 69495, Pierre Bénite, Cedex, France.|EA 3738, UCBL, Faculté de Médicine Lyon Sud, BP 12, 69921, Oullins, Cedex, France.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D019008:Drug Resistance, Neoplasm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007274:Injections, Intraperitoneal / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis