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Frankinet L, Bhatt A, Alcazer V, Classe JM, Bereder JM, Meeus P, Pomel C, Mithieux F, Abboud K, Wermert R, Lavoue V, Marchal F, Glehen O, Bakrin N. Role of Hyperthermic Intraperitoneal Chemotherapy Combined with Cytoreductive Surgery as Consolidation Therapy for Advanced Epithelial Ovarian Cancer. Ann Surg Oncol 2023; 30:3287-3299. [PMID: 36820940 DOI: 10.1245/s10434-023-13242-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Patients with advanced epithelial ovarian cancer who undergo incomplete surgery followed by six cycles of chemotherapy could benefit from second-look or consolidation cytoreductive surgery (CCRS). The primary goal of this study was to evaluate the overall survival (OS) in patients undergoing complete CCRS and the factors affecting survival. The secondary goal was to study the benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in these patients. METHODS This was a retrospective analysis of 173 patients with CCRS with (n = 118) or without (n = 55) HIPEC treated at 12 French centers. Only patients having a completeness of cytoreduction (CC) 0/1 resection and a minimum of 5 years of follow-up were included. HIPEC was performed systematically for all patients except those treated at the four centers that did not perform HIPEC. RESULTS The median Peritoneal Cancer Index was 6 (range 0-33). Closed HIPEC was performed in 59 (34.1%) patients and open HIPEC was performed in 56 (32.3%) patients. Grade 3-4 complications occurred in 64 (36.9%) patients. The median OS was 35.67 months (95% confidence interval [CI] 29.8-46.1) and was significantly longer for CCRS + HIPEC (31.4 months without HIPEC and 42.5 months with HIPEC; p = 0.022). On multivariate analysis, closed HIPEC (hazard ratio [HR] 0.46, 95% CI 0.29-0.73; p < 0.001) resulted in a longer OS, and age > 65 years (HR 2.17, 95% CI 1.14-4.11; p = 0.018) and bowel resection (HR 1.98, 95% CI 1.27-3.08; p = 0.020) led to a shorter OS. On multivariate logistic regression analysis, closed HIPEC (odds ratio 0.18; p = 0.001) was associated with a lower risk of dying at 5 years. CONCLUSIONS CCRS was performed with an acceptable morbidity and resulted in good overall survival. The role of HIPEC in addition to CCRS should be evaluated in prospective, randomized studies and the closed technique prospectively compared with the open technique.
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Affiliation(s)
- Lisa Frankinet
- Department of General Surgery, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Vincent Alcazer
- Department of Medical Oncology, Centre Hospitalier Lyon Sud, Lyon, France
| | - Jean-Marc Classe
- Department of Surgical Oncology, Centre René Gauducheau, Nantes, France
| | - Jean-Marc Bereder
- Department of Surgical Oncology, Centre Hospitalier L'Archet, Nice, France
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Christophe Pomel
- Department of Surgical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Francois Mithieux
- Department of Surgical Oncology, Hopital Privé Jean Mermoz, Lyon, France
| | - Karine Abboud
- Department of Surgical Oncology, Hopital Nord St Etienne, St Étienne, France
| | - Romauld Wermert
- Department of Surgical Oncology, Centre Paul Papin, Angers, France
| | - Vincent Lavoue
- Department of Surgical Oncology, Centre Hospitralo-Universitaire Rennes, Rennes, France
| | - Frederic Marchal
- Department of Surgical Oncology, Institut de Cancérologir de Lorraine Alexis Vautrin, Université de Lorraine, Nancy, France
| | - Olivier Glehen
- Department of General Surgery, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France. .,CICLY, Lyon 1 University, Lyon, France.
| | - Naoual Bakrin
- Department of General Surgery, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France.,CICLY, Lyon 1 University, Lyon, France
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Bhatt A, Alcazer V, Frankinet L, Bakrin N, Glehen O. ASO Author Reflections: Redefining Consolidation Cytoreductive Surgery for Ovarian Cancer. Ann Surg Oncol 2023; 30:3300-3301. [PMID: 36808321 DOI: 10.1245/s10434-023-13244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Vincent Alcazer
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Lisa Frankinet
- Department of Surgical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France.,Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Claude Bernard University Lyon 1, Lyon, France
| | - Olivier Glehen
- Department of Surgical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Lyon, France. .,Centre pour l'Innovation en Cancérologie de Lyon (CICLY), Claude Bernard University Lyon 1, Lyon, France.
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Lyu M, Lu J, Shen Y, Chen Q, Deng F, Wang J. No obvious advantage of hyperthermic intraperitoneal chemotherapy after interval debulking surgery in the treatment of advanced ovarian cancer: A retrospective study. Front Surg 2022; 9:997344. [PMID: 36171817 PMCID: PMC9510392 DOI: 10.3389/fsurg.2022.997344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/22/2022] [Indexed: 12/09/2022] Open
Abstract
Objective To study the efficacy of interval debulking surgery (IDS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) compared to IDS alone for the treatment of ovarian cancer after neoadjuvant chemotherapy (NACT). Methods We conducted a retrospective study of patients with stage IIIC/IV high-grade serous ovarian carcinoma who underwent surgery at our center from January 2018 to December 2019. Patients who underwent IDS after NACT with (N = 20) or without (N = 42) HIPEC were included. HIPEC was administered after surgery and was combined with 1–2 courses of intraperitoneal hyperthermic perfusion with normal saline only. We analyzed clinical information and outcomes for the two groups. Results The median progression-free survival (PFS) was 14.05 months in the IDS plus HIPEC group and 12.97 months in the IDS group (P = 0.597). The median overall survival (OS) was not reached. After adjustment for age between the two groups, the differences in PFS and OS remained nonsignificant. The change ratio of postoperative CA-125 to preoperative CA-125 was 0.66 in the IDS plus HIPEC group and 0.53 in the IDS group (P = 0.341). The difference in human epididymis protein 4 (HE-4) change ratio between the two groups was nonsignificant (P = 0.225). No significant difference was observed in the occurrence of grade 3 and 4 adverse events between the two groups (P = 0.201). Conclusion After NACT, IDS plus HIPEC did not show significant PFS and tumor index change ratio benefits over IDS alone in patients with primary ovarian cancer. Further investigations are needed to assess the role of HIPEC in the treatment of ovarian cancer.
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Affiliation(s)
| | | | | | | | - Fei Deng
- Correspondence: Fei Deng Jinhua Wang
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Comment on: hyperthermic intraperitoneal chemotherapy as consolidation treatment of advanced stage ovarian cancer. Obstet Gynecol Sci 2021; 65:103-104. [PMID: 34758477 PMCID: PMC8784940 DOI: 10.5468/ogs.21273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022] Open
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