title: Evaluation of extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  Although standard treatment for advanced epithelial ovarian cancer (EOC) consists of surgical debulking and intravenous platinum- and taxane-based chemotherapy, favorable oncological outcomes have been recently reported with the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of the study was to analyze feasibility and results of CRS and HIPEC in patients with advanced EOC.
  
  
  METHODS
  This is an open, prospective phase 2 study including patients with primary or recurrent peritoneal carcinomatosis due to EOC. Thirty-nine patients with a mean (SD) age of 57.3 (9.7) years (range, 34-74 years) were included between September 2005 and December 2009. Thirty patients (77%) had recurrent EOC and 9 (23%) had primary EOC.
  
  
  RESULTS
  For HIPEC, cisplatin and paclitaxel were used for 11 patients (28%), cisplatin and doxorubicin for 26 patients (66%), paclitaxel and doxorubicin for 1 patient (3%), and doxorubicin alone for 1 patient (3%). The median intra-abdominal outflow temperature was 41.5°C. The mean peritoneal cancer index (PCI) was 11.1 (range, 1-28); and according to the intraoperative tumor extent, the tumor volume was classified as low (PCI <15) or high (PCI ≥15) in 27 patients (69%) and 12 patients (31%), respectively. Microscopically complete cytoreduction was achieved for 35 patients (90%), macroscopic cytoreduction was achieved for 3 patients (7%), and a gross tumor debulking was performed for 1 patient (3%). Mean hospital stay was 23.8 days. Postoperative complications occurred in 7 patients (18%), and reoperations in 3 patients (8%). There was one postoperative death. Recurrence was seen in 23 patients (59%) with a mean recurrence time of 14.4 months (range, 1-49 months).
  
  
  CONCLUSIONS
  Hyperthermic intraperitoneal chemotherapy after extensive CRS for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in highly selected patients. Additional follow-up and further studies are needed to determine the effects of HIPEC on survival.
authors.affiliation: Unit of General Surgery I, Ospedali Riuniti of Bergamo, Bergamo, Italy. lansaloni@ospedaliriuniti.bergamo.it
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.forename: Vanni
authors.initials: V
authors.lastname: Agnoletti
authors.forename: Andrea
authors.initials: A
authors.lastname: Amadori
authors.forename: Fausto
authors.initials: F
authors.lastname: Catena
authors.forename: Davide
authors.initials: D
authors.lastname: Cavaliere
authors.forename: Federico
authors.initials: F
authors.lastname: Coccolini
authors.forename: Pierandrea
authors.initials: P
authors.lastname: De Iaco
authors.forename: Monica
authors.initials: M
authors.lastname: Di Battista
authors.forename: Massimo
authors.initials: M
authors.lastname: Framarini
authors.forename: Filippo
authors.initials: F
authors.lastname: Gazzotti
authors.forename: Claudio
authors.initials: C
authors.lastname: Ghermandi
authors.forename: Barbara
authors.initials: B
authors.lastname: Kopf
authors.forename: Maristella
authors.initials: M
authors.lastname: Saponara
authors.forename: Francesca
authors.initials: F
authors.lastname: Tauceri
authors.forename: Carlo
authors.initials: C
authors.lastname: Vallicelli
authors.forename: Giorgio Maria
authors.initials: GM
authors.lastname: Verdecchia
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000628:therapy; D004317:Doxorubicin / Q000008:administration & dosage; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D004317:Doxorubicin; D017239:Paclitaxel; D002945:Cisplatin