Effect of platinum sensitivity on the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) in recurrent epithelial ovarian cancer

J Gynecol Obstet Hum Reprod. 2021 May;50(5):101844. doi: 10.1016/j.jogoh.2020.101844. Epub 2020 Jun 23.

Abstract

Introduction: Hyperthermic intraperitoneal chemotherapy following cytoreductive surgery (CRS) is a treatment strategy that has been evaluated in recurrent ovarian cancer. The aim of this study was to examine if survival was similar regardless of platinum sensitivity.

Methods: A retrospective study of women with recurrent platinum sensitive or resisteant epithelial ovarian cancer who were treated with cytoreductive surgery (CRS) and HIPEC between the years 2010-2018 was performed. Recurrence free (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method.

Results: Thirty-five (72.9 %) were platinum sensitive (PS) and 13 (27.1 %) were platinum resistant (PR). The complete cytoreduction (R0) rate was higher in the PS patients as compared to PR (85.7 % vs 53.8 %; p = 0.017). Median follow-up was 16.9 (range, 11.7-34.5) months. The median recurrence free survival in the patients who had a R0 resection was 22.3 months in PS and 11.1 months in PR patients (p = 0.017), respectively. Median overall survival was 26.9 months in the PR patients, while it had not been reached in the PS patients. In the patients with PS recurrence, the mean treatment free interval (TFI) prior to HIPEC was 1.6 years and following HIPEC, 40 % of those patients were recurrence free at 2 years. In the patients with PR recurrence, the mean TFI prior to HIPEC was 4.6 months and following HIPEC, 61.5 % of those patients had a longer TFI, with a mean increase of 10.1 months.

Conclusion: Although surgery is not considered standard treatment in PR ovarian cancer, in carefully selected patients, surgery with HIPEC could extend the treatment-free interval.

Keywords: HIPEC; Platinum resistant; Platinum sensitive; Recurrent ovarian cancer.

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Carcinoma, Ovarian Epithelial / drug therapy*
  • Carcinoma, Ovarian Epithelial / mortality
  • Carcinoma, Ovarian Epithelial / surgery
  • Cisplatin / administration & dosage
  • Combined Modality Therapy / methods
  • Cytoreduction Surgical Procedures
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Drug Administration Schedule
  • Drug Resistance, Neoplasm
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperthermic Intraperitoneal Chemotherapy / methods*
  • Hyperthermic Intraperitoneal Chemotherapy / mortality
  • Kaplan-Meier Estimate
  • Middle Aged
  • Mitomycin / administration & dosage
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / surgery
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / mortality
  • Ovarian Neoplasms / surgery
  • Paclitaxel / administration & dosage
  • Retrospective Studies
  • Time Factors

Substances

  • Mitomycin
  • Doxorubicin
  • Paclitaxel
  • Cisplatin