J Gynecol Oncol.  2015 Jan;26(1):54-61. 10.3802/jgo.2015.26.1.54.

Hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel in advanced ovarian cancer: a multicenter prospective observational study

• Coccolini
• Campanati
• Catena F
• Ceni V
• Ceresoli M
• Jimenez Cruz J
• Lotti M
• Magnone S
• Napoli J
• Rossetti D
• De Iaco P
• Frigerio L
• Pinna A
• Runnebaum
• Ansaloni L

• KMID: 2158803
• DOI: http://doi.org/10.3802/jgo.2015.26.1.54

Abstract

OBJECTIVE
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been recently reported with favorable oncological outcomes as treatment of advanced epithelial ovarian cancer (EOC). The aim of this study was to demonstrate the feasibility of CRS+HIPEC with cisplatin and paclitaxel for the treatment of advanced EOC.
METHODS
This is a prospective observational study of 54 patients, from April 2007 to October 2013, with primary or recurrent peritoneal carcinomatosis due to EOC. The mean age was 54.51+/-9.34. Thirty patients (59%) had primary EOC, and 24 patients (41%) had recurrent disease.
RESULTS
Mean peritoneal cancer index was 10.11 (range, 0 to 28), complete cytoreduction (CC0) was achieved for 47 patients (87%), CC1 for seven patients (13%). Patients with suboptimal cytoreduction (CC2 and CC3) were not included in the study. The mean stay in intensive care unit was 4.73+/-5.51 days and the mean hospitalization time was 24.0+/-10.03 days. We did not observe any intraoperative death. Seven patients (13%) required additional operations. Three patients (5.6%) died within 30 days from the procedure. Severe complications were seen in 19 patients (35.2%). During the follow-up period, disease recurred in 33 patients (61.1%); the median disease-free survival time was 12.46 months and the median overall survival time was 32.91 months.
CONCLUSION
CRS+HIPEC with cisplatin and paclitaxel for advanced EOC is feasible with acceptable morbidity and mortality. Additional follow-up and further studies are needed to determine the effects of HIPEC on long term survival.

Keyword

Cisplatin; Disease-free Survival; Ovarian Neoplasms; Paclitaxel; Prospective studies

MeSH Terms

Adult
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/adverse effects/*therapeutic use
Cisplatin/administration & dosage/adverse effects
Combined Modality Therapy
Cytoreduction Surgical Procedures/adverse effects/methods
Feasibility Studies
Female
Humans
Hyperthermia, Induced/adverse effects/*methods
Infusions, Parenteral
Kaplan-Meier Estimate
Middle Aged
Neoplasm Recurrence, Local/drug therapy/surgery
Ovarian Neoplasms/*drug therapy/surgery
Paclitaxel/administration & dosage/adverse effects
Prospective Studies
Treatment Outcome
Cisplatin
Paclitaxel

Figure

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  Fig. 1 Disease-free (A) and overall survival (B) in 54 patients with primary advanced or recurrent ovarian cancer treated with cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel.

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  Fig. 2 (A) Effect of chemosensitivity on overall survival. (B) Effect of severe complication on OS. (C) Effect of severe complication on OS in the subgroup of chemosensitive patients. NS, not significant.

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  Fig. 3 (A) Disease-free survival and (B) overall survival in 54 patients with ovarian cancer treated with cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel between primary and recurrent diseases. NS, not significant.

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