title: Secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent epithelial ovarian cancer: a multi-institutional study.
abstract: OBJECTIVE
  To assess the efficacy and morbidity and mortality of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer (EOC).
  
  
  METHODS
  A retrospective study conducted using information extracted from a multi-institutional prospective database on peritoneal surface malignancies (PSMs). Setting Four Italian centres specializing in locoregional treatment of PSM.
  
  
  METHODS
  Patients with recurrent EOC.
  
  
  METHODS
  Fifty-six patients underwent 57 combined procedures. CRS was performed using peritonectomy procedures and HIPEC using the closed-abdomen technique with cisplatin and doxorubicin or cisplatin and mitomycin-C.
  
  
  METHODS
  Overall survival (OS), progression-free survival (PFS), morbidity and mortality rates.
  
  
  RESULTS
  The median age of the patients was 55.2 years (range 30-75 years). The median peritoneal cancer index was 15.2 (range 4-30). Forty-seven patients had microscopic residual disease (completeness of cytoreduction, CC-0), seven had residual disease ≤2.5 mm (CC-1) and one had residual disease >2.5 mm (CC>2). Major complications occurred in 15 patients (26.3%), and procedure-related mortality occurred in three patients (5.3%). The median follow-up time was 23.1 months. The median OS and PFS were 25.7 (95% CI 20.3-31.0) and 10.8 (95% CI 5.4-16.2) months, respectively. The 5-year OS and PFS were 23% and 7%, respectively. Independent prognostic factors affecting OS according to the multivariate analysis were Eastern Cooperative Oncology Group performance status, preoperative serum albumin, and completeness of cytoreduction.
  
  
  CONCLUSIONS
  Patients with recurrent EOC treated with CRS and HIPEC showed promising results in terms of outcome. The combined treatment strategy could benefit subsets of patients wider than that defined for conventional secondary debulking surgery without HIPEC. These data warrant further evaluation in randomised clinical trials.
authors.affiliation: Peritoneal Surface Malignancy Program, Department of Surgery, National Cancer Institute, Milan, Italy. marcello.deraco@istitutotumori.mi.it
authors.forename: M
authors.initials: M
authors.lastname: Deraco
authors.forename: S
authors.initials: S
authors.lastname: Virzì
authors.forename: D R
authors.initials: DR
authors.lastname: Iusco
authors.forename: F
authors.initials: F
authors.lastname: Puccio
authors.forename: A
authors.initials: A
authors.lastname: Macrì
authors.forename: C
authors.initials: C
authors.lastname: Famulari
authors.forename: M
authors.initials: M
authors.lastname: Solazzo
authors.forename: S
authors.initials: S
authors.lastname: Bonomi
authors.forename: A
authors.initials: A
authors.lastname: Grassi
authors.forename: D
authors.initials: D
authors.lastname: Baratti
authors.forename: S
authors.initials: S
authors.lastname: Kusamura
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000077216:Carcinoma, Ovarian Epithelial; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010537:Peritoneum / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D016685:Mitomycin; D004317:Doxorubicin; D002945:Cisplatin