title: Cytoreduction (Peritonectomy Procedures) Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Advanced Ovarian Cancer: Retrospective Italian Multicenter Observational Study of 511 Cases.
abstract: OBJECTIVE
  The aim of this study was to help with the process of selecting patients with advanced ovarian cancer to undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) by analyzing outcome data at distinct clinical time points reflecting the natural history of the disease.
  
  
  METHODS
  In a retrospective Italian multicenter study investigating patients with advanced ovarian cancer who underwent CRS plus HIPEC between 1998 and 2014, we analyzed data for consecutive patients at eight treatment time points: primary debulking surgery (PDS); interval debulking surgery after partial response, after no response, and after a pathologic complete response to neoadjuvant chemotherapy; first recurrence with a progression-free interval >12, <12 months, or >12 months in patients who underwent further chemotherapy before CRS and HIPEC; and patients who underwent two or more CRS procedures and chemotherapy lines before CRS and HIPEC.
  
  
  RESULTS
  The 511 enrolled patients underwent 3373 procedures; 72.6% achieved complete cytoreduction, with an overall major morbidity of 17.4%. At a median follow-up of 53.8 months, overall survival (OS) was 54.2 months (95% confidence interval [CI] 44-58.4) and progression-free (PFS) survival was 16.6 months (95% CI 14.7-19.1). Outcome analysis in patients in whom CRS plus HIPEC was used for primary advanced cancer or recurrent ovarian cancer showed significant differences in OS and PFS according to the time points analyzed. Multivariate analysis identified completeness of CRS, Peritoneal Cancer Index, and the times when patients underwent CRS plus HIPEC as independent prognostic factors.
  
  
  CONCLUSIONS
  This selective information on survival should help in interpreting the findings from ongoing randomized studies focusing on CRS plus HIPEC in patients with advanced ovarian cancer.
authors.affiliation: Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Giorgio
authors.affiliation: General Surgery and Gynecologic Oncology Unit, Sant'Orsola Hospital, Bologna, Italy.
authors.forename: Pierandrea
authors.initials: P
authors.lastname: De Iaco
authors.affiliation: Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Simone
authors.affiliation: Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garofalo
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: General Surgery and Gynecologic Oncology Unit, Sant'Orsola Hospital, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Unit of Surgery and Advanced Oncologic Therapies, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: Giorgio Maria
authors.initials: GM
authors.lastname: Verdecchia
authors.affiliation: General Surgery Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ansaloni
authors.affiliation: Department of Human Pathology, University of Messina, Messina, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macrì
authors.affiliation: General Surgery Unit, San Giovanni di Dio Hospital, Florence, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappellini
authors.affiliation: General Surgery UnitPoliclinico Polispecialistico Multimedica, Sesto San Giovanni, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Ceriani
authors.affiliation: Department of Gynecological Oncology, CRO National Cancer Institute, Aviano, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Biacchi
authors.affiliation: Unit of Surgical Oncology, Candiolo Cancer Institute, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vaira
authors.affiliation: Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Valle
authors.affiliation: Department of Surgery 'P. Valdoni', Sapienza University of Rome, Rome, Italy. paolo.sammartino@uniroma1.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Sammartino
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D065426:Cytoreduction Surgical Procedures / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D007263:Infusions, Parenteral; D007558:Italy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000473:pathology*; D018579:Patient Selection; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate