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Brault C, Brind’Amour A, de Guerke L, Auclair MH, Sideris L, Dubé P, Soucisse M, Tremblay JF, Bernard L, Piedimonte S, Fortin S. Combined Interval Cytoreductive Surgery and Carboplatin-Based Hyperthermic Intraperitoneal Chemotherapy in Advanced Primary High-Grade Serous Ovarian Cancer. Curr Oncol 2023; 30:10272-10282. [PMID: 38132382 PMCID: PMC10742627 DOI: 10.3390/curroncol30120748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Combining interval cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival in advanced epithelial ovarian carcinoma (EOC). Although limited, growing evidence regarding carboplatin-based HIPEC highlights its potential. This retrospective study included all patients with advanced primary high-grade serous ovarian cancer who underwent interval CRS combined with carboplatin-based HIPEC at our Canadian tertiary care center between 2014 and 2020. We identified 40 patients with a median age of 61 years. The median peritoneal cancer index was 13 and complete cytoreduction was achieved in 38 patients (95%). Median hospital stay was 13 days and there were four admissions to the intensive care unit (10%) and six readmissions (15%). Severe adverse events occurred in eight patients (20%) and there was no perioperative death. Recurrence was seen in 33 patients (82%) with a median DFS of 18.0 months and a median overall survival of 36.4 months. Multivariate analyses showed that age, peritoneal cancer index, completeness of cytoreduction, occurrence of severe complications, and bowel resection did not significantly impact DFS or OS in our cohort. Interval CRS combined with carboplatin-based HIPEC for advanced primary EOC is associated with acceptable morbidity and oncological outcomes. Larger studies are required to determine the long-term outcomes.
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Affiliation(s)
- Claudèle Brault
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Lara de Guerke
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Marie-Hélène Auclair
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Lucas Sideris
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Pierre Dubé
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Mikaël Soucisse
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Jean-François Tremblay
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Laurence Bernard
- Division of Gynecologic Oncology, Royal Victoria Hospital, Montreal, QC H4A 3J1, Canada
| | - Sabrina Piedimonte
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
| | - Suzanne Fortin
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC H1T 2M4, Canada
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Souadka A, Essangri H, Majbar MA, Benkabbou A, Boutayeb S, You B, Glehen O, Mohsine R, Bakrin N. Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in Ovarian Cancer: An Umbrella Review of Meta-Analyses. Front Oncol 2022; 12:809773. [PMID: 35615149 PMCID: PMC9124965 DOI: 10.3389/fonc.2022.809773] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background The utility of heated intraperitoneal chemotherapy (HIPEC) in the management of epithelial ovarian cancer (EOC) has been assessed in several randomised clinical trials and meta-analyses, and it is still a subject of controversy. Therefore, we performed an umbrella review of existing meta-analyses to summarise the outcomes of HIPEC and cytoreductive surgery (CRS) association in ovarian cancer. Methods We examined the MEDLINE, Cochrane Library, Scopus, Prospero, Web of Science and Science Direct from inception to May 30, 2020, for meta-analyses of randomised controlled trials and observational studies. Analyses of overall survival, disease free survival and progression survival were performed separately for primary and recurrent ovarian cancers. Results We identified 6 meta-analyses investigating the association of HIPEC with CRS in the management of ovarian cancer. Three year overall survival was significantly improved by the association of CRS and HIPEC for primary (HR: 0.66, 95%CI:0.56-0.78) and recurrent ovarian cancers (HR:0.50, 95%CI:0.38-0.64). This benefit was also demonstrated on disease-free survival for primary (HR: 0.54, 95%CI:0.48-0.61) and recurrent ovarian cancer (HR: 0.60, 95%CI:0.46-0.78). The pooled hazard ratios confirmed the advantage of HIPEC and CRS association with respect to CRS alone on progression free survival for primary and recurrent ovarian cancer respectively with HR: 0.50, 95%CI: 0.43-0.58 and HR: 0.59, 95%CI: 0.41-0.85. Conclusion While waiting for the results of the current prospective studies, the present umbrella study suggests that HIPEC performed at the end of CRS may be a complementary effective asset for ovarian cancer patient management.
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Affiliation(s)
- Amine Souadka
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Hajar Essangri
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Mohammed Anass Majbar
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Saber Boutayeb
- Medical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Benoit You
- Département d’oncologie médicale Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Olivier Glehen
- Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
| | - Raouf Mohsine
- Surgical Oncology Department, National Institute of Oncology, University Mohammed V in Rabat, Rabat, Morocco
| | - Naoual Bakrin
- Département de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
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Youssef A, Haskali MB, Gorringe KL. The Protein Landscape of Mucinous Ovarian Cancer: Towards a Theranostic. Cancers (Basel) 2021; 13:5596. [PMID: 34830751 PMCID: PMC8616050 DOI: 10.3390/cancers13225596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
MOC is a rare histotype of epithelial ovarian cancer, and current management options are inadequate for the treatment of late stage or recurrent disease. A shift towards personalised medicines in ovarian cancer is being observed, with trials targeting specific molecular pathways, however, MOC lags due to its rarity. Theranostics is a rapidly evolving category of personalised medicine, encompassing both a diagnostic and therapeutic approach by recognising targets that are expressed highly in tumour tissue in order to deliver a therapeutic payload. The present review evaluates the protein landscape of MOC in recent immunohistochemical- and proteomic-based research, aiming to identify potential candidates for theranostic application. Fourteen proteins were selected based on cell membrane localisation: HER2, EGFR, FOLR1, RAC1, GPR158, CEACAM6, MUC16, PD-L1, NHE1, CEACAM5, MUC1, ACE2, GP2, and PTPRH. Optimal proteins to target using theranostic agents must exhibit high membrane expression on cancerous tissue with low expression on healthy tissue to afford improved disease outcomes with minimal off-target effects and toxicities. We provide guidelines to consider in the selection of a theranostic target for MOC and suggest future directions in evaluating the results of this review.
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Affiliation(s)
- Arkan Youssef
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3000, Australia;
| | - Mohammad B. Haskali
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3000, Australia;
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Kylie L. Gorringe
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3000, Australia;
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Zivanovic O, Chi DS, Zhou Q, Iasonos A, Konner JA, Makker V, Grisham RN, Brown AK, Nerenstone S, Diaz JP, Schroeder ED, Langstraat CL, Paroder V, Lakhman Y, Soldan K, Su K, Gardner GJ, Andikyan V, Guo J, Jewell EL, Long Roche K, Troso-Sandoval T, Lichtman SM, Moukarzel LA, Dessources K, Abu-Rustum NR, Aghajanian C, Tew WP, Beumer J, Sonoda Y, O'Cearbhaill RE. Secondary Cytoreduction and Carboplatin Hyperthermic Intraperitoneal Chemotherapy for Platinum-Sensitive Recurrent Ovarian Cancer: An MSK Team Ovary Phase II Study. J Clin Oncol 2021; 39:2594-2604. [PMID: 34019431 PMCID: PMC8330970 DOI: 10.1200/jco.21.00605] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The purpose of this phase II study was to evaluate hyperthermic intraperitoneal chemotherapy (HIPEC) with carboplatin for recurrent ovarian cancer during secondary cytoreductive surgery. MATERIALS AND METHODS Patients were intraoperatively randomly assigned to carboplatin HIPEC (800 mg/m2 for 90 minutes) or no HIPEC, followed by five or six cycles of postoperative IV carboplatin-based chemotherapy, respectively. Based on a binomial single-stage pick-the-winner design, an arm was considered winner if ≥ 17 of 49 patients were without disease progression at 24 months post-surgery. Secondary objectives included postoperative toxicity and HIPEC pharmacokinetics. RESULTS Of 98 patients, 49 (50%) received HIPEC. Complete gross resection was achieved in 82% of the HIPEC patients and 94% of the standard-arm patients. Bowel resection was performed in 37% of patients in the HIPEC arm compared with 65% in the standard (P = .008). There was no perioperative mortality and no difference in use of ostomies, length of stay, or postoperative toxicity. At 24 months, eight patients (16.3%; 1-sided 90% CI, 9.7 to 100) were without progression or death in the HIPEC arm and 12 (24.5%; 1-sided 90% CI, 16.5 to 100) in the standard arm. With a medium follow-up of 39.5 months, 82 patients progressed and 37 died. The median progression-free survival in the HIPEC and standard arms were 12.3 and 15.7 months, respectively (hazard ratio, 1.54; 95% CI, 1 to 2.37; P = .05). There was no significant difference in median overall survival (52.5 v 59.7 months, respectively; hazard ratio, 1.39; 95% CI, 0.73 to 2.67; P = .31). These analyses were exploratory. CONCLUSION HIPEC with carboplatin was well tolerated but did not result in superior clinical outcomes. This study does not support the use of HIPEC with carboplatin during secondary cytoreductive surgery for platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Oliver Zivanovic
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Dennis S. Chi
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Qin Zhou
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alexia Iasonos
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jason A. Konner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Rachel N. Grisham
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Amy K. Brown
- Hartford Healthcare Cancer Institute, Hartford, CT
| | | | | | | | | | - Viktoriya Paroder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Krysten Soldan
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Katy Su
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ginger J. Gardner
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Vaagn Andikyan
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Elizabeth L. Jewell
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kara Long Roche
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Stuart M. Lichtman
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lea A. Moukarzel
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kimberly Dessources
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Nadeem R. Abu-Rustum
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Carol Aghajanian
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William P. Tew
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Jan Beumer
- UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Yukio Sonoda
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Coccolini F, Fugazzola P, Montori G, Ansaloni L, Chiarugi M. Intraperitoneal chemotherapy for ovarian cancer with peritoneal metastases, systematic review of the literature and focused personal experience. J Gastrointest Oncol 2021; 12:S144-S181. [PMID: 33968435 DOI: 10.21037/jgo-2020-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epithelial ovarian cancer (EOC) causes 60% of ovarian cancer cases and is the fourth most common cause of death from cancer in women. The standard of care for EOC includes a combination of surgery followed by intravenous chemotherapy. Intraperitoneal (IP) chemotherapy (CT) has been introduced into the therapeutic algorithm of EOC with positive results. To explore existing results regarding intraperitoneal chemotherapy a systematic review of the literature and an analysis of our own institutional prospective database of patients treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for EOC at different stages were conducted. The focused report concerning our personal experience with advanced EOC treated with cytoreductive surgery and HIPEC produced the following results: In 57 patients cisplatin + paclitaxel as HIPEC was the only significant factor improving overall survival (OS) at multivariate analysis (OR 6.54, 95% CI: 1.24-34.47, P=0.027). Patients treated with HIPEC cisplatin + paclitaxel showed a median OS of 46 months (SD 6.4, 95% CI: 33.4-58.6), while patients treated with other HIPEC regimens showed a median OS of 12 months (SD 3.1, 95% CI: 6.0-18.0). The 2y-OS was 72% and 3y-OS was 68% for cisplatin + paclitaxel as HIPEC, while the 2y- and 3y-OS was 0% for other HIPEC regimens. Patients treated with HIPEC cisplatin + paclitaxel showed a median disease-free survival (DFS) of 13 months (SD 1.6, 95% CI: 9.9-16.1), while patients treated with other HIPEC regimens showed a median DFS of 8 months (SD 3.1, 95% CI: 1.9-14.1). In conclusion, HIPEC cisplatin + paclitaxel in ovarian cancer showed positive results that may be considered semi-definitive according to the level of evidence and should be considered a starting point for further investigations. At present HIPEC cisplatin + paclitaxel should be proposed to patients with advanced ovarian cancer as standard treatment at almost all stages of disease. Platinum + taxane-based intraperitoneal regimens demonstrated superior results compared to other regimens.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Paola Fugazzola
- General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
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Ha HI, Lim MC. How do we perform hyperthermic intraperitoneal chemotherapy in ovarian cancer? -a narrative review. Gland Surg 2021; 10:1235-1243. [PMID: 33842270 DOI: 10.21037/gs-20-425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ovarian malignancy is a leading cause of death caused by gynecologic cancer worldwide because it is mainly found in the advanced stage and recurs in most patients even after cytoreductive surgery and intravenous (IV) chemotherapy. Prevention of recurrence of primary disease and treatment of recurrent ovarian cancer are still remained as major interest and lots of researchers investigate novel treatment to find optimal method. Even though intraperitoneal (IP) chemotherapy turns out to increase the overall survival, it is not widely used because of adverse event. As an alternative treatment for IP chemotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC) is emerging a new way. Thanks to much research and use in other cancer species, such as the colorectal cancer cytoreductive surgery followed by HIPEC is becoming a promising treatment. However, randomized controlled trials and unbiased data in ovarian cancer patients are still needed for the establishment of therapy. Moreover, among the current situation in which treatments such as bevacizumab or PARP inhibitor have been found to be effective and have been widely used, it may be necessary to establish the role in the combination of HIPEC. This article is a comprehensive review of the HIPEC in ovarian cancer to introduce techniques, treatment results, and clinical trials of HIPEC.
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Affiliation(s)
- Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Myong Cheol Lim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Jou J, Zimmer Z, Charo L, Yau C, Saenz C, Eskander R, McHale M, Veerapong J, Plaxe S, Binder P. HIPEC after neoadjuvant chemotherapy and interval debulking is associated with development of platinum-refractory or -resistant disease. Gynecol Oncol 2020; 161:25-33. [PMID: 33293046 DOI: 10.1016/j.ygyno.2020.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe our single-institution oncologic outcomes of patients who received neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS We compared clinicopathologic information and outcomes for all patients with advanced stage, high-grade serous ovarian cancer who received NACT and IDS with (N = 20) or without (N = 48) HIPEC at our institution from 2010 to 2019 RESULTS: Mean age (62 years with HIPEC and 60 years without HIPEC) and proportion of stage 4 disease (40% for both) did not differ between cohorts. HIPEC patients had higher rates of complete cytoreduction (95% vs 50%), longer mean duration of surgery (530 vs. 216 min), more grade 3 or 4 postoperative complications (65% vs. 4%), and longer mean length of hospital stay (8 vs. 5 days). HIPEC patients had significantly higher risk for platinum-refractory progression or platinum-resistance recurrence (50% vs 23%; RR = 2.18; 95% CI 1.11, 4.30, p = 0.024). Median progression free survival (11.5 vs. 12 months) and all-cause mortality (19.1 vs. 30.5 months) in the HIPEC and non-HIPEC cohorts, respectively, did not differ CONCLUSIONS: HIPEC was associated with increased risk for platinum refractory or resistant disease. Higher surgical complexity may contribute to higher complication rates without improving oncologic outcomes in our patients. Further investigations and long-term follow-up are needed to assess the utility of HIPEC in primary treatment of advanced stage ovarian cancer.
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Affiliation(s)
- Jessica Jou
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA.
| | - Zoe Zimmer
- Department of Obstetrics and Gynecology, Balboa Naval Hospital, San Diego, CA, USA
| | - Lindsey Charo
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Christopher Yau
- Division of Body Imaging, Department of Radiology, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Cheryl Saenz
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Ramez Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Michael McHale
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Jula Veerapong
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Steven Plaxe
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
| | - Pratibha Binder
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
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Mikkelsen MS, Blaakaer J, Petersen LK, Schleiss LG, Iversen LH. Pharmacokinetics and toxicity of carboplatin used for hyperthermic intraperitoneal chemotherapy (HIPEC) in treatment of epithelial ovarian cancer. Pleura Peritoneum 2020; 5:20200137. [PMID: 33575463 PMCID: PMC7829861 DOI: 10.1515/pp-2020-0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives Carboplatin is frequently used in various doses for hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of epithelial ovarian cancer (EOC) although its pharmacokinetics, including focus on the perfusion time, has not been evaluated when used in modern era cytoreductive surgery (CRS). The aim was to evaluate the pharmacokinetics and hematological toxicity of carboplatin used for HIPEC with a perfusion time of 90 min. Methods Fifteen patients with stage III–IV primary EOC received CRS and 90 min of HIPEC with carboplatin at dose 800 mg/m2. For the pharmacokinetic analysis, perfusate and blood samples were obtained during HIPEC and up to 48 h after HIPEC (blood only). Hematological toxicity within 30 days was graded according to Common Terminology Criteria for Adverse Events. Severe toxicity (grades 3–5) is reported. Results Mean maximum concentration of carboplatin was 12 times higher in perfusate than plasma (mean CmaxPF=348 µg/mL (range: 279–595 µg/mL) versus mean CmaxPL=29 µg/mL (range: 21–39 µg/mL)). Mean terminal half-life of carboplatin in perfusate was 104 min (range: 63–190 min) and mean intraperitoneal-to-plasma area under the concentration-time curve (AUC) ratio was 12.3 (range: 7.4–17.2). Two patients (13%) had grade 3 neutropenia within 30 days. No grade 4–5 hematological toxicities were identified. Conclusions Carboplatin has a favorable pharmacokinetic profile for 90 min HIPEC administration, and the hematological toxicity was acceptable at dose 800 mg/m2. Large interindividual differences were found in the pharmacokinetic parameters, making risk of systemic exposure difficult to predict.
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Affiliation(s)
- Mette Schou Mikkelsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Blaakaer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Lone Kjeld Petersen
- Open Patient Explorative Data Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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9
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Brind'Amour A, Brault C, Sidéris L, De Guerke L, Auclair MH, Dubé P, Fortin S. Carboplatin Hyperthermic Intraperitoneal Chemotherapy in the Management of Primary Stage IVB Endometrial Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:247-250. [PMID: 33039314 DOI: 10.1016/j.jogc.2020.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endometrial cancer presenting with peritoneal metastases carries a poor prognosis. The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to the surgical management of these patients has been studied in recent years, but only with cisplatin. CASES This is a series of 3 patients presenting with endometrial cancer and synchronous peritoneal metastases who underwent cytoreductive surgery and carboplatin HIPEC as primary treatment. Complete cytoreductive surgery was achieved for each patient. No grade 3-5 complications were observed. Two patients died at 12 and 18 months, respectively, and 1 patient was alive with disease at 29 months. CONCLUSION This case series suggests that the addition of carboplatin HIPEC to the surgical management of peritoneal metastases from endometrial cancer is safe as primary treatment. However, long-term survival remains poor.
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Affiliation(s)
| | - Claudèle Brault
- Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
| | - Lucas Sidéris
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montréal, QC; Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
| | - Lara De Guerke
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montréal, QC; Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
| | - Marie-Hélène Auclair
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montréal, QC; Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
| | - Pierre Dubé
- Division of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montréal, QC; Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
| | - Suzanne Fortin
- Division of Gynecologic Oncology, Maisonneuve-Rosemont Hospital, Montréal, QC; Department of Obstetrics & Gynecology, University of Montréal, Montréal, QC
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10
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Mikkelsen MS, Christiansen T, Petersen LK, Blaakaer J, Iversen LH. Morbidity after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with carboplatin used for ovarian, tubal, and primary peritoneal cancer. J Surg Oncol 2019; 120:550-557. [PMID: 31267569 DOI: 10.1002/jso.25603] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/07/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertherm intraperitoneal chemotherapy (HIPEC) is increasingly used in the treatment of ovarian, tubal, and primary peritoneal cancer (OC). The aim was to evaluate short-term morbidity of cytoreductive surgery (CRS) and carboplatin HIPEC. METHODS Prospective feasibility study performed from January 2016 to December 2017. Twenty-five patients with primary OC (FIGO III-IV) received upfront or interval CRS combined with carboplatin HIPEC at dose 800 mg/m 2 . Primary outcome measurements: grade 3 to 5 adverse events within 30 days according to Common Terminology Criteria for Adverse Events. Secondary outcome measurements: reoperation rate, length of hospital stay, readmission rate, and time from surgery to systemic chemotherapy administration. RESULTS No deaths (grade 5) or grade 4 adverse events were observed. Eleven patients (44.0%) experienced at least one grade 3 adverse event, the most common being an infection (28.0%) and neutropenia (12.0%). The reoperation rate was 8.0%. The median hospital stay was 14 days (range 9-25 days), and five patients (25.0%) were readmitted within 30 days after surgery. Median time from surgery to the administration of the first dose of systemic chemotherapy was 41 days (range 24-81 days). CONCLUSION Our small-scale prospective study supports that CRS and carboplatin HIPEC used for primary advanced-stage OC is feasible with acceptable morbidity.
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Affiliation(s)
- Mette Schou Mikkelsen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thora Christiansen
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
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Abstract
Epithelial ovarian cancer classically presents with vague persistent gastrointestinal, urologic, or nonacute abdominal/pelvic symptoms (bloating, early satiety, discomfort). Ultimately, a pelvic examination or imaging identifies an adnexal mass typically with accompanied advanced peritoneal dissemination. Management involves aggressive cytoreductive surgery in combination with platinum and taxane chemotherapy. Over the last 20 years, optimal resection and mode and timing of chemotherapy have evolved. The authors review the initial diagnosis and management and present the available data and recommendations to guide the decision tree of when to use neoadjuvant, intraperitoneal, HIPEC, dose-dense, and maintenance chemotherapy in the front-line treatment of epithelial ovarian cancer.
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Affiliation(s)
- Brian Orr
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Robert P Edwards
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Interval Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in First-Line Treatment for Advanced Ovarian Carcinoma: A Feasibility Study. Int J Gynecol Cancer 2017; 26:912-7. [PMID: 27051055 DOI: 10.1097/igc.0000000000000696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We conducted a phase 2 trial to assess the feasibility of interval cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in patients with stage III and IV pleural ovarian carcinoma in first-line treatment with no macroscopic residual disease after surgery. METHODS Patients could be treated either with primary CS with HIPEC followed by 6 conventional cycles of chemotherapy or with 3 or 4 cycles of neoadjuvant chemotherapy before CS with HIPEC and 3 postoperative chemotherapy cycles. Hyperthermic intraperitoneal chemotherapy was performed with cisplatin (50 mg/m) for 60 minutes, only in case of complete cytoreduction. RESULTS Nineteen patients were included in the study, and they all underwent neoadjuvant chemotherapy before CS. Sixteen patients underwent complete CS with HIPEC. There was no mortality, and morbidity of CS with HIPEC was acceptable. The HIPEC procedure did not prevent the administration of the standard first-line treatment. In the 16 patients who underwent CS with HIPEC, the outcomes were very good. CONCLUSION Our study shows an acceptable toxicity of adding HIPEC to the standard first-line treatment in patients with stage III ovarian carcinoma treated with interval CS. Further studies are needed to confirm the role of HIPEC in the treatment of ovarian carcinoma.
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Heated IntraPEritoneal Chemotherapy (HIPEC) for Patients With Recurrent Ovarian Cancer: A Systematic Literature Review. Int J Gynecol Cancer 2016; 26:661-70. [DOI: 10.1097/igc.0000000000000664] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundDespite advances in surgical oncology, most patients with primary ovarian cancer develop a recurrence that is associated with a poor prognosis. The aim of this review was to establish the impact of Heated IntraPEritoneal Chemotherapy (HIPEC) in the overall survival of patients with recurrent ovarian cancer.MethodsA search of PubMed/MEDLINE databases was performed in February 2015 using the terms “recurrent ovarian cancer,” “cytoreductive surgery/cytoreduction,” and “heated/hyperthermic intraperitoneal chemotherapy.” Only English articles with available abstracts assessing the impact of HIPEC in patients with recurrent ovarian cancer were examined. The primary outcome measure was overall survival, whereas secondary outcomes included disease-free survival and HIPEC-related morbidity.ResultsSixteen studies with 1168 patients were analyzed. Most studies were Level IV, with 4 studies graded as Level III and 1 Level II. Cisplatin was the main chemotherapeutic agent used, but variations were observed in the actual technique, temperature of perfusate, and duration of treatment. In patients undergoing cytoreductive surgery and HIPEC, the overall survival ranged between 26.7 and 35 months, with disease-free survival varying between 8.5 and 48 months. Heated IntraPEritoneal Chemotherapy seems to confer survival benefits to patients with recurrent disease, with a randomized controlled study reporting that the overall survival is doubled when cytoreductive surgery is compared with cytoreductive surgery and chemotherapy (13. 4 vs 26.7 months). Heated IntraPEritoneal Chemotherapy–related morbidity ranged between 13.6% and 100%, but it was mainly minor and not significantly different from that experienced by patients who only underwent cytoreduction.ConclusionsCytoreductive surgery and HIPEC seem to be associated with promising results in patients with recurrent ovarian cancer. Large international prospective studies are required to further quantify the true efficacy of HIPEC and identify the optimal treatment protocol for a maximum survival benefit.
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Petrillo M, Anchora LP, Scambia G, Fagotti A. Cytoreductive Surgery Plus Platinum-Based Hyperthermic Intraperitoneal Chemotherapy in Epithelial Ovarian Cancer: A Promising Integrated Approach to Improve Locoregional Control. Oncologist 2016; 21:532-4. [PMID: 27009941 PMCID: PMC4861369 DOI: 10.1634/theoncologist.2015-0500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/04/2016] [Indexed: 12/18/2022] Open
Abstract
Epithelial ovarian cancer (EOC) remains the most lethal among gynecological malignancies. Evidence strongly suggests that administration of platinum-based hyperthermic intraperitoneal chemotherapy after cytoreductive surgery may represent an effective strategy to adequately treat both visible and microscopic disease, thus improving locoregional control.
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Affiliation(s)
- Marco Petrillo
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Pedone Anchora
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Fagotti
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy Department of Surgery, Division of Minimally Invasive Gynecology, University of Perugia, Perugia, Italy
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Polom K, Roviello G, Generali D, Marano L, Petrioli R, Marsili S, Caputo E, Marrelli D, Roviello F. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer. Int J Hyperthermia 2016; 32:298-310. [DOI: 10.3109/02656736.2016.1149233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Boisen MM, Richard SD, Holtzman MP, Edwards RP, Kelley JL, Choudry MH, Bartlett D, Huang M. Hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancers: is there a role? J Gastrointest Oncol 2016; 7:10-7. [PMID: 26941980 DOI: 10.3978/j.issn.2078-6891.2015.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
- Michelle M Boisen
- 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
| | - Scott D Richard
- 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
| | - Matthew P Holtzman
- 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
| | - Robert P Edwards
- 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
| | - Joseph L Kelley
- 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
| | - Mohammad Haroon Choudry
- 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
| | - David Bartlett
- 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
| | - Marilyn Huang
- 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
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Lambert LA, Harris A. Palliative cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: current clinical practice or misnomer? J Gastrointest Oncol 2016; 7:112-21. [PMID: 26941989 DOI: 10.3978/j.issn.2078-6891.2015.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) is being used more and more frequently for the management of peritoneal carcinomatosis. Despite significant improvements in oncologic outcomes and the risk of complications and mortality, CRS/HIPEC remains one of the most morbid treatments offered for advanced cancers. Consequently CRS/HIPEC is still considered controversial by many, even in the setting of cancers that are potentially curable. However, as high volume surgical oncologists become more experienced with CRS/HIPEC, the potential role of "palliative CRS/HIPEC" in the management of peritoneal carcinomatosis is being raised. Given the often limited survival benefit expected after CRS/HIPEC, understanding the impact of the treatment on quality of life (QOL) needs to be an essential part of the decision to proceed and is critical to optimizing recovery afterwards. This article reviews the potential definitions of "palliative CRS/HIPEC" in various clinical contexts and describes the current state of the QOL experience after CRS/HIPEC.
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Affiliation(s)
- Laura A Lambert
- Divisions of Surgical Oncology and Palliative Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Ariana Harris
- Divisions of Surgical Oncology and Palliative Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
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Goodman MD, McPartland S, Detelich D, Saif MW. Chemotherapy for intraperitoneal use: a review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy. J Gastrointest Oncol 2016; 7:45-57. [PMID: 26941983 DOI: 10.3978/j.issn.2078-6891.2015.111] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Peritoneal spread of tumors is a major problem in cancer management. Patients develop a marked deterioration in quality of life and shortened survival. This is in part due to bowel obstructions, marked ascites, and overall increase debilitation. Standard medical management has shown to be inadequate for the treatment of these problems. Surgery can palliate symptoms, however, it is unable to be complete at the microscopic level by a significant spillage of tumor cells throughout the abdomen. Chemotherapy can have some improvement in symptoms however it is short lived due to poor penetration into the peritoneal cavity. The role of intraperitoneal chemotherapy is to maximize tumor penetration and optimize cell death while minimizing systemic toxicity. Hyperthermic intraperitoneal chemotherapy (HIPEC) and early post-operative intraperitoneal chemotherapy (EPIC) are two treatment methods that serve this role and have been shown to improve survival. This review will discuss different chemotherapies used for both of these treatment options.
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Affiliation(s)
- Martin D Goodman
- 1 Department of Surgery, 2 Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Sarah McPartland
- 1 Department of Surgery, 2 Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Danielle Detelich
- 1 Department of Surgery, 2 Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Muhammad Wasif Saif
- 1 Department of Surgery, 2 Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA
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Huo Y, Richards A, Liauw W, Morris D. Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2015; 41:1578-89. [DOI: 10.1016/j.ejso.2015.08.172] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 01/27/2023] Open
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Helm CW. Hyperthermic intraperitoneal chemotherapy for ovarian cancer: is there a role? J Gynecol Oncol 2015; 26:1-2. [PMID: 25609161 PMCID: PMC4302278 DOI: 10.3802/jgo.2015.26.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Rettenmaier MA, Mendivil AA, Abaid LN, Brown JV, Micha JP, Wilcox AM, Goldstein BH. The feasibility of administering varying high-dose consolidation hyperthermic intraperitoneal chemotherapy with carboplatin in the treatment of ovarian carcinoma. Arch Gynecol Obstet 2014; 291:1381-6. [PMID: 25516177 DOI: 10.1007/s00404-014-3590-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intriguing method of delivery wherein the cytotoxic agent is continuously heated and circulated throughout the peritoneum in an attempt to bolster drug efficacy. Despite HIPEC's potential, ascertaining the optimal dose without compromising patient tolerability remains indeterminate. METHODS We retrospectively evaluated 52 advanced stage ovarian cancer patients who were treated with consolidation HIPEC with carboplatin at varying doses (e.g., AUC 6, 8 or 10) subsequent to optimal debulking surgery and the attainment of a clinical complete response to their primary chemotherapy regimen. The following patient and operative characteristics were abstracted: demographics, surgery and pathology data, chemotherapy regimen, intraoperative results, toxicity, postoperative complications, length of hospital stay and survival data. RESULTS Twelve patients received HIPEC carboplatin at an AUC 6, 15 subjects were treated with carboplatin at an AUC 8 and 25 underwent carboplatin at an AUC 10. There were no intraoperative complications during the administration of HIPEC; mean estimated blood loss was 50 mL and length of hospital stay was 1.65 days. In the overall study population, 5 patients developed grade 3/4 anemia and 33 subjects exhibited grade ≤2 thrombocytopenia and neutropenia. Thirteen patients also developed grade ≤2 nausea on postoperative day 1, which was successfully addressed with anti-emetic therapy; there were no hospital readmissions. CONCLUSIONS The results from the current evaluation suggest that consolidation hyperthermic intraperitoneal chemotherapy with carboplatin is both feasible and reasonably tolerated, even at an AUC of 10. However, additional, randomized study of this procedure incorporating chemotherapy dose escalation with a more extensive patient population is warranted.
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Affiliation(s)
- Mark A Rettenmaier
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA
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Quality of life after cytoreductive surgery and intraoperative hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: a systematic review. Eur J Surg Oncol 2014; 40:1605-13. [PMID: 25242382 DOI: 10.1016/j.ejso.2014.08.477] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/24/2014] [Accepted: 08/13/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cytoreductive Surgery (CRS) accompanied by Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a promising technique in the treatment of peritoneal metastatic disease. The complexity and the potential adverse effects of the procedure can significantly affect patients' Quality of Life (QoL). Few studies have assessed the impact of CRS + HIPEC in patients' QoL using structured and validated tools. This is a systematic review of the currently available published data, investigating the QoL after performing CRS + HIPEC for tumours of varying primary origin. METHODS We performed a systematic review of the studies indexed in PubMed database until July 2014, using as key phrase "quality of life" and "intraperitoneal chemotherapy", including studies using only validated questionnaires for assessing quality of life parameters. RESULTS 20 studies were identified that matched the criteria set. The results of these studies, although of significant heterogeneity, clearly demonstrate that although overall QoL scores drop in the immediate postoperative period, at an average of 3 months post procedure they recover to 80%-100% or even exceed baseline values. Furthermore, between 6 and 12 months postoperatively, overall QoL is improved in survivors compared to pre-operative status. CONCLUSIONS CRS and HIPEC is feasible as a treatment modality in selected patients with peritoneal metastatic disease and can preserve or even improve patients' overall quality of life.
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Cripe J, Tseng J, Eskander R, Fader AN, Tanner E, Bristow R. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Carcinoma: Analysis of 30-Day Morbidity and Mortality. Ann Surg Oncol 2014; 22:655-61. [DOI: 10.1245/s10434-014-4026-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 12/26/2022]
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Le Brun JF, Campion L, Berton-Rigaud D, Lorimier G, Marchal F, Ferron G, Oger AS, Dravet F, Jaffre I, Classe JM. Survival Benefit of Hyperthermic Intraperitoneal Chemotherapy for Recurrent Ovarian Cancer: A Multi-institutional Case Control Study. Ann Surg Oncol 2014; 21:3621-7. [DOI: 10.1245/s10434-014-3693-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Indexed: 11/18/2022]
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Security and efficiency of a closed-system, turbulent-flow circuit for hyperthermic intraperitoneal chemotherapy after cytoreductive ovarian surgery: perioperative outputs. Arch Gynecol Obstet 2014; 290:121-9. [PMID: 24488579 DOI: 10.1007/s00404-014-3153-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 01/09/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To present physiologic intraoperative data and immediate postoperative outcomes of patients diagnosed with epithelial ovarian cancer submitted to cytoreductive surgery and hyperthermic peritoneal intraoperative chemotherapy (HIPEC) with a closed-circuit, turbulent-flow system. MATERIALS AND METHODS A closed-circuit system with CO2 turbulent flow was used for paclitaxel HIPEC during 60 min for patients diagnosed with stage II or higher and recurrent epithelial ovarian cancer. Perioperative hemodynamic and metabolic statuses were followed, as well as physiologic recovery during the first 12 postoperative hours. A non-parametric statistical analysis was performed. RESULTS At the end of the hyperthermia phase, temperature was 37.7 ± 0.6 °C, heart rate 88 ± 19 bpm, cardiac index 2.8 ± 0.5 L min(-1) m(-2), stroke volume variation 14.6 ± 3.6 % and extravascular lung water 8.7 ± 1.9 mL kg(-1). No hyperdynamic status was recorded. The length of stay in the ICU was 2½ days, and 12.7 ± 7 days in hospital. Average postoperative intubation time was 11.7 ± 17.4 h. At the ICU admission time, glucose, lactic acid and hemoglobin were the only values out of range, but close to normal. SOFA median was 3 at admission and 0 the following day. CONCLUSION A turbulent-flow, closed-circuit use for hyperthermic peritoneal intraoperative chemotherapy resulted in no hyperdynamic response or coagulopathy, had good tolerance and promoted early physiologic recovery.
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