title: Hyperthermic Intraperitoneal Chemotherapy after Secondary Cytoreduction in Epithelial Ovarian Cancer: A Single-center Comparative Analysis.
abstract: BACKGROUND
  Although the standard of care after recurrence of epithelial ovarian cancer (EOC) is chemotherapy, increasing data suggest that combining cytoreductive surgery with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising option for patients with recurrent EOC. Our aim was to determine the prognostic value of the addition of HIPEC to secondary cytoreductive surgery (SCR) in recurrent EOC.
  
  
  METHODS
  We analyzed a series of 79 patients with platinum-sensitive recurrent EOC who were treated from May 2000 to January 2014. Fifty patients who underwent SCR were compared to 29 who had SCR in combination with HIPEC.
  
  
  RESULTS
  The SCR group had a higher median age (58.4 years) compared to the SCR + HIPEC group (51.6 years) (p = 0.006). The median hospital stay length was longer for SCR + HIPEC versus SCR patients (11 and 8 days, respectively; p = 0.009). More subjects experienced National Cancer Institute grade III-IV morbidity in the SCR + HIPEC group (34.5 %) compared to the SCR group (10.6 %) (p = 0.015). Conversely, there were no deaths in the SCR + HIPEC group and 2 (4.0 %) deaths the SCR group. The median disease-free survival did not differ between SCR and SCR + HIPEC patients (18.6 and 15.8 months, respectively; p = 0.82); nor did median overall survival (59.3 and 58.3 months, respectively; p = 0.95). The presence of carcinomatosis was the only variable that remained linked to a higher risk of recurrence and death in the multivariate analysis.
  
  
  CONCLUSIONS
  Our data suggest that the addition of HIPEC to cytoreduction in patients with recurrent platinum-sensitive EOC does not improve survival.
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil. glbaiocchi@yahoo.com.br.
authors.forename: Glauco
authors.identifier: http://orcid.org/0000-0002-8193-5582
authors.initials: G
authors.lastname: Baiocchi
authors.affiliation: Department of Pelvic Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Fabio Oliveira
authors.initials: FO
authors.lastname: Ferreira
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Mantoan
authors.affiliation: Department of Medical Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Alexandre Andre Balieiro Anastacio
authors.initials: AA
authors.lastname: da Costa
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Carlos Chaves
authors.initials: CC
authors.lastname: Faloppa
authors.affiliation: Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Lillian Yuri
authors.initials: LY
authors.lastname: Kumagai
authors.affiliation: Department of Medical Oncology, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Celso Abdon Lopes
authors.initials: CA
authors.lastname: de Mello
authors.affiliation: Department of Pelvic Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Renata Mayumi
authors.initials: RM
authors.lastname: Takahashi
authors.affiliation: Department of Pelvic Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Wilson Toshihiko
authors.initials: WT
authors.lastname: Nakagawa
authors.affiliation: Department of Pelvic Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Aguiar
authors.affiliation: Department of Pelvic Surgery, AC Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Ademar
authors.initials: A
authors.lastname: Lopes
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery / Q000628:therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate