title: Hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancers: is there a role?
abstract: BACKGROUND
  Hyperthermic intraperitoneal chemotherapy (HIPEC) is often used to treat gastrointestinal malignancies and is of interest in epithelial ovarian cancer (EOC) given the propensity for intraperitoneal spread. The role of HIPEC in the treatment of gynecologic malignancies is not well defined. We sought to describe clinical characteristics and outcomes of our patient population treated with HIPEC.
  
  
  METHODS
  IRB approval was obtained. Patients diagnosed with EOC and treated with HIPEC from January 2007 until December 2013 were identified using a prospectively maintained HIPEC database. Patient charts were abstracted to identify patient demographic information, treatment characteristics, and outcome data. Statistical analysis was descriptive.
  
  
  RESULTS
  Thirty-four patients were identified. Mean age at diagnosis was 56.5 years. The majority of cases (28, 82%) were of serous histology. The indications for HIPEC administration were as follows: 9% primary treatment, 41% first recurrence, 26% second recurrence, and 24% consolidative therapy in the setting of primary or recurrent disease. The majority of patients (21, 62%) received mitomycin C. The other drugs administered include cisplatin (10, 29%), oxaliplatin (2, 6%), and carboplatin (1, 3%). Mean length of hospital stay was 9 days (range, 3-39 days). The rates of postoperative bacteremia and hematologic toxicity were 6% and 54%, respectively. Seven (21%) patients developed transient renal dysfunction, and this was seen almost exclusively in the patients who received cisplatin. One (3%) additional patient had renal dysfunction that persisted longer than 30 days post-operative but did not go on to require dialysis. There were no perioperative deaths in this cohort. Eleven (32%) patients received additional chemotherapy following HIPEC administration. At a median follow-up of 20 months (range, 3-87 months), eight patients are alive with disease, seven have no evidence of disease, 14 have died of their disease, and five patients have been lost to follow-up.
  
  
  CONCLUSIONS
  This data supports a reasonable side effect profile of treatment of EOC with HIPEC. Prospective studies are needed to elucidate the optimal drug and patient population that would derive the most benefit from treatment with HIPEC.
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Boisen
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Richard
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Holtzman
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mohammad Haroon
authors.initials: MH
authors.lastname: Choudry
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bartlett
authors.affiliation: 1 Division of Gynecologic Oncology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA ; 2 Division of Gynecologic Oncology, Hahnemann University Hospital, Philadelphia, PA, USA ; 3 Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Huang
keywords: Epithelial ovarian cancer (EOC); chemotherapy; intraperitoneal infusions