title: Peritoneal carcinomatosis from ovarian epithelial primary: combined aggressive treatment.
abstract: Cytoreductive surgery followed by platinum based systemic chemotherapy is an effective treatment for advanced ovarian epithelial carcinoma, resulting in up to 80% complete response (CR) rate; however only 30% of patients reaches 5-year survival. The low extra-abdominal relapse attitude leads to consider the opportunity of treatment intensification combining aggressive cytoreductive surgery with locoregional chemotherapy for FIGO stage III/IV ovarian carcinoma recurrent after the first-line chemotherapy, having still a curative intent.
  
  
  METHODS
  An "open" intra-abdominal hyperthermic perfusion with 25 mg/m(2)/lt cisplatin of perfusate or 50 mg/m(2)cisplatin plus 15 mg/m(2)doxorubicin was carried out throughout the abdomino-pelvic cavity on 42 patients affected by peritoneal carcinomatosis from ovarian primary, soon after tumor removal en bloc with regional involved peritoneum. Clinical and oncologic data have been prospectively recorded on a dedicated database.
  
  
  RESULTS
  Forty-two patients, submitted to peritonectomy, achieved no residual macroscopic disease in 83% of the cases. Hyperthermic chemoperfusion was performed in 95% of the patients. Major complications were observed in 21.4%, being directly correlated to the duration of the surgical procedure (p=0.03). The operative mortality was 4.7%. At a mean follow up of 22 months, the overall 3-year survival was 61.4%, with a median survival of 41 months.
  
  
  CONCLUSIONS
  Complete cytoreduction is possible for the majority of patients, allowing encouraging survival to be reached. Careful selection of patients could reduce surgical risk and further improve survival.
authors.affiliation: Department of General Surgery and Organ Transplantation, San Camillo-Forlanini Hospital, Rome, Italy. francescocavaliere@fastwebnet.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavaliere
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Mario
authors.initials: M
authors.lastname: Valle
authors.forename: Orietta
authors.initials: O
authors.lastname: Federici
authors.forename: Gianluca
authors.initials: G
authors.lastname: Liotta
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perri
authors.forename: Franco
authors.initials: F
authors.lastname: Di Filippo
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garofalo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ialongo
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery