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Ostrowski T, Litwiński J, Gęca K, Świetlicka I, Polkowski WP, Skórzewska M. A Clinician's perspective on the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer management. Surg Oncol 2024; 56:102117. [PMID: 39096575 DOI: 10.1016/j.suronc.2024.102117] [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: 01/08/2024] [Revised: 07/02/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
The prevention of intraperitoneal spread is of utmost importance in the management of advanced ovarian cancer (OC), thus demanding the exploration of innovative treatment techniques. The propensity of OC to spread to the peritoneum has highlighted the potential of local therapy as a promising approach. Among the proposed treatments thus far are several local intraperitoneal therapies, with hyperthermic intraperitoneal chemotherapy (HIPEC) being one of them. The application of HIPEC may potentially enhance the survival rates of patients with OC, as indicated by a recent publication of high-quality prospective data. The incorporation of HIPEC in conjunction with primary cytoreductive surgery (CRS) does not have a significant impact on either overall survival (OS) or disease-free survival (DFS). However, the incorporation of HIPEC alongside interval CRS, followed by systemic chemotherapy (CTH), markedly enhances both OS and DFS. The most recent data also substantiates the effectiveness of HIPEC in recurrent ovarian cancer (ROC), resulting in an improvement of survival outcomes. Additional research will contribute to the improvement of the HIPEC regimen and technique, as well as the precise identification of patients who will gain the most advantage from this treatment approach. It is recommended to discuss and update (inter)national clinical guidelines for managing patients with advanced OC and peritoneal involvement.
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Affiliation(s)
- Tomasz Ostrowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Jakub Litwiński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
| | - Izabela Świetlicka
- Department of Biophysics of Biological Structures and Systems, University of Life Sciences in Lublin, Poland
| | - Wojciech P Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
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Climent MT, Serra A, Balaguer C, Llueca A. Should We Abandon Intraperitoneal Chemotherapy in the Treatment of Advanced Ovarian Cancer? A Meta-Analysis. J Pers Med 2023; 13:1636. [PMID: 38138863 PMCID: PMC10745120 DOI: 10.3390/jpm13121636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Ovarian cancer is the gynaecological malignancy with the highest mortality and diagnosis often occurs in its advanced stages. Standard treatment in these cases is based on complete cytoreductive surgery with adjuvant intravenous chemotherapy. Other types of treatment are being evaluated to improve the prognosis of these patients, including intraperitoneal chemotherapy and antiangiogenic therapy. These may improve survival or time to relapse in addition to intravenous chemotherapy. OBJECTIVE The aim of this meta-analysis is to determine whether treatment with intravenous chemotherapy remains the gold standard, or whether the addition of intraperitoneal chemotherapy has a benefit in overall survival (OS) and disease-free interval (DFS). MATERIALS AND METHODS A literature search was carried out in Pubmed and Cochrane, selecting clinical studies and systematic reviews published in the last 10 years. Statistical analysis was performed using the hazard ratio measure in the RevMan tool. RESULTS Intraperitoneal chemotherapy shows a benefit in OS and DFS compared with standard intravenous chemotherapy. The significant differences in OS (HR: 0.81 CI 95% 0.74-0.88) and in DFS (HR: 0.81 CI 95% 0.75-0.87) are statistically significant (p < 0.00001). There were no clinical differences in toxicity and side-effects. CONCLUSION Intraperitoneal chemotherapy is an option that improves OS and DFS without significant toxicity regarding the use of intravenous chemotherapy alone. However, prospective studies are needed to determine the optimal dose and treatment regimen that will maintain the benefits while minimising side effects and toxicity and the profile of patients who will benefit most from this treatment.
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Affiliation(s)
- Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
| | - Carolina Balaguer
- Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain;
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncological Surgery (MUAPOS), Department of Obstetrics and Gynaecology, Hospital General Universitario de Castellón, 12004 Castellón, Spain; (A.S.); (A.L.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellón, Spain
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Llueca A, Ibañez MV, Cascales P, Gil-Moreno A, Bebia V, Ponce J, Fernandez S, Arjona-Sanchez A, Muruzabal JC, Veiga N, Diaz-Feijoo B, Celada C, Gilabert-Estelles J, Aghababyan C, Lacueva J, Calero A, Segura JJ, Maiocchi K, Llorca S, Villarin A, Climent MT, Delgado K, Serra A, Gomez-Quiles L, Llueca M. Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study. Cancers (Basel) 2023; 15:4271. [PMID: 37686547 PMCID: PMC10486645 DOI: 10.3390/cancers15174271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. RESULTS A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58-0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64-1.20; p = 0.44). There was no increase in complications in the CRSH group. CONCLUSION The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
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Affiliation(s)
- Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | | | - Pedro Cascales
- Department of General Surgery, Hospital Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain;
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Vicente Bebia
- Gynecologic Oncology Unit, Department of Gynecology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (A.G.-M.); (V.B.)
| | - Jordi Ponce
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Sergi Fernandez
- Department of Gynecology, University Hospital of Bellvitge, 08907 Barcelona, Spain; (J.P.); (S.F.)
| | - Alvaro Arjona-Sanchez
- Unit of Surgical Oncology and Pancreatic Surgery, University Hospital Reina Sofia, 14004 Cordoba, Spain;
| | - Juan Carlos Muruzabal
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Nadia Veiga
- Department of Gynecologic Oncology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain; (J.C.M.); (N.V.)
| | - Berta Diaz-Feijoo
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Cristina Celada
- Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain; (B.D.-F.); (C.C.)
| | - Juan Gilabert-Estelles
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, University General Hospital of Valencia, 46014 Valencia, Spain; (J.G.-E.); (C.A.)
| | - Javier Lacueva
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Alicia Calero
- Unit of Peritoneal Carcinomatosis, Department of General Surgery, University General Hospital of Elche, 03203 Elche, Spain; (J.L.); (A.C.)
| | - Juan Jose Segura
- Hepatobiliopancreatic Surgery and Peritoneal Oncology Surgery Unit, General Surgery and Digestive System Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Karina Maiocchi
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Alvaro Villarin
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Katty Delgado
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12071 Castellon, Spain
| | - Luis Gomez-Quiles
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), University General Hospital of Castellon, 12004 Castellon, Spain; (K.M.); (S.L.); (A.V.); (M.T.C.); (K.D.); (A.S.); (L.G.-Q.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Maria Llueca
- Department of Obstetrics and Gynecology, Joan XXIII University Hospital of Tarragona, 43005 Tarragona, Spain;
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González Gil A, Cerezuela Fernández-de Palencia Á, Gómez Ruiz ÁJ, Gil Gómez E, López Hernández F, Nieto Ruiz A, Martínez J, Marhuenda I, Cascales Campos PA. HIPEC in Ovarian Cancer Is the Future… and Always Will Be? Results from a Spanish Multicentric Survey. Cancers (Basel) 2023; 15:3481. [PMID: 37444591 DOI: 10.3390/cancers15133481] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/29/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
Ovarian cancer is the leading cause of death due to gynecological tumors in the female population. Despite optimal first-line treatment, including cytoreduction and platinum-based systemic chemotherapy, recurrences are frequent. The use of hyperthermic intraperitoneal chemotherapy (HIPEC) has been criticized, especially because of the lack of randomized controlled trials (RCTs) with convincing results to support the use of HIPEC in patients with ovarian cancer with peritoneal dissemination. In 2018, the clinical trial published by Van Driel et al. reported improved outcomes in favor of HIPEC treatment with cisplatin. In this study, we conducted a national survey within the Spanish group of peritoneal surgical oncology (Grupo Español de Cirugía Oncológica Peritoneal, GECOP) to explore the impact of the results of this RCT on clinical practice. A total of 33 groups completed the survey. Routine clinical practice was not changed in 28 of the 33 groups (85%) based on the results of the Van Driel trial. Despite the results of this RCT, most groups considered that more RCTs are needed and that, in the future, HIPEC may become the standard of care. In conclusion, the results from RCTs evaluating HIPEC treatment in patients with ovarian cancer has not been transferred to clinical practice.
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Affiliation(s)
- Alida González Gil
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | | | - Álvaro Jesús Gómez Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Elena Gil Gómez
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Francisco López Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Aníbal Nieto Ruiz
- Departamento de Ginecología y Obstetricia, Unidad de Ginecología Oncológica, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Jerónimo Martínez
- Departamento de Oncología Médica, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Iván Marhuenda
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
| | - Pedro Antonio Cascales Campos
- Departamento de Cirugía, Unidad de Cirugía Oncológica Peritoneal, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-ARRIXACA, 30120 Murcia, Spain
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