Hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancers: is there a role?

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Hyperthermic intraperitoneal chemotherapy (HIPEC), which is often used to treat gastrointestinal cancers, appears to be well tolerated in patients with epithelial ovarian cancer as well, a study published in the Journal of Gastrointestinal Oncology has shown.

Because the role of HIPEC in the treatment of gynecologic malignancies remains unclear, researchers sought to describe clinical characteristics and outcomes of patients with epithelial ovarian cancer treated with HIPEC. For the study, researchers analyzed data from 34 patients who received HIPEC between 2007 and 2013. Their average age was 56.5 years and 82% had serous carcinoma.

Results showed that 9% received HIPEC as primary treatment, 41% for first recurrence, 26% for second recurrence, and 24% as consolidation therapy in the first- or subsequent-line therapy setting. Researchers found that 62% received mitomycin C as HIPEC, 29% received cisplatin, 6% received oxaliplatin, and 3% received carboplatin.

In terms of outcomes, the average length of hospitalization was 9 days, and postoperative bacteremia and hematologic toxicity were reported in 6% and 54% of patients, respectively. Transient renal dysfunction, particularly due to cisplatin toxicity, occurred in 21% of patients. Furthermore, after a median follow-up of 20 months, 7 patients had no evidence of disease, 8 were alive with disease, 14 died due to their cancer, and 5 were lost to follow-up.

Ultimately, further studies are required to determine the progression-free and overall survival benefit of HIPEC and to determine which agents administered as HIPEC agents would provide the most benefit to this patient population.

Journal of Gastrointestinal Oncology
Journal of Gastrointestinal Oncology

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.

Keywords: Epithelial ovarian cancer (EOC); chemotherapy; intraperitoneal infusions 

Submitted Jul 25, 2015. Accepted for publication Sep 03, 2015.

doi: 10.3978/j.issn.2078-6891.2015.103

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