A novel treatment protocol with 6 cycles of neoadjuvant chemotherapy followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in stage III primary ovarian cancer |
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Institution: | 1. Unidad De Cirugía De La Carcinomatosis Peritoneal, Departamento De Cirugía General, Spain;2. Radiology Department, Memorial Sloan-Kettering Cancer Center, USA;3. Unidad De Ginecología Oncológica, Servicio De Ginecología y Obstetricia, Spain;4. Peritoneal Carcinomatosis Unit, Department of Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain;1. Department of Obstetrics and Gynaecology, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, United Kingdom;2. Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Rd., Birmingham, B18 7QH, United Kingdom;3. Institute of Cancer and Genomic Sciences, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, United Kingdom |
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Abstract: | BackgroundFew prospective studies investigated neoadjuvant chemotherapy (NAC), interval cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer. We report the results of a phase II study where 6 rather than 3 cycles of NAC, followed by CRS and HIPEC, were adopted (HIPEC_ovaio, EudraCT number 2007-005674-31).Materials and methodsBetween 2007 and 2014, 56 patients with stage III primary ovarian cancer and peritoneal carcinomatosis were assigned to 6 cycles of platinum and taxane-based NAC. Of these, two had progression, 8 underwent palliative surgery, and 46 had CRS and HIPEC.ResultsA complete pathological response was observed in 9 patients. Of 46 patients who completed the treatment protocol, 29 had no macroscopic residual tumor. Postoperative grade III morbidity rate was 28.2%; no grade IV complications or mortality events were observed. Five-year overall survival (OS) of the entire series was 36 ± 7% (median: 36, 95% CI: 26–45 months). In 46 patients treated by CRS and HIPEC, 5-year OS was 42 ± 8% (median: 53, 95% CI: 29–76 months), and 5-year progression-free survival was 26 ± 7% (median: 23, 95% CI: 19–27 months). Completeness of cytoreduction, peritoneal cancer index and FIGO stage resulted as significant prognostic factors.ConclusionsA novel protocol consisting of 6 cycles of NAC, followed by CRS and HIPEC, is associated with notable improvement in peritoneal carcinomatosis, limited postoperative morbidity risk and high survival rates in responders, and could deserve further investigations in randomized clinical trials. |
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Keywords: | Ovarian cancer Peritoneal carcinomatosis HIPEC Cytoreductive surgery Neoadjuvant chemotherapy |
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