Treatment of Recurrent Epithelial Ovarian Cancer with Secondary Cytoreduction and Continuous Intraoperative Intraperitoneal Hyperthermic Chemoperfusion (CIIPHCP)

Abstract

Objective: Evaluation of the combined effect of secondary cytoreduction and continuous intraoperative intraperitoneal hyperthermic chemoperfusion (CIIPHCP), in the treatment of recurrent ovarian cancer, in a phase II clinical study.
Material and Methods: Twenty consecutive, heavily pre-treated patients with recurrent epithelial ovarian cancer, were treated with a combination of cytoreductive surgery and CIIPHCP. All patients had extended peritoneal carcinomatosis. In 14 out of the 20 pts (70 %) the recurrence occurred during chemotherapy or within 6 months after the end of the chemotherapy. Thirteen pts (65 %) had preoperatively malignant ascites, whereas the remaining seven pts (35 %) had positive peritoneal cytology washings.
Results: No complications emerged during operation and CIIPHCP. Median ascites-free period after CIIPHCP was 21 months (range 3-109). Median survival time for patients with residual disease less than 1.5 cm was 29.0 months, whereas for patients with residual disease equal or greater than 1.5 cm, the median survival time was 7.0 months. This difference was statistically significant (P < 0.05).
Conclusions: The survival data of our patients and the disappearance of the malignant ascites postoperatively suggest that continuous intraoperative intraperitoneal hyperthermic chemoperfusion is an effective treatment option for patients with recurrent ovarian cancer.

Zusammenfassung

Ziel: Auswertung der Kombination aus sekundärer Tumorreduktion und kontinuierlicher intraoperativer intraperitonealer hyperthermischer Chemoperfusion (CIIPHCP) in der Therapie des rezidivierenden Ovarialkarzinoms im Rahmen einer klinischen Studie II. Phase.
Material und Methoden: Zwanzig aufeinanderfolgende, operativ und chemotherapeutisch vorbehandelte Patientinnen mit rezidivierenden epithelialen Ovarialkarzinomen wurden mit einer Kombination aus tumorreduktiver Operation und CIIPHCP behandelt. Alle Patientinnen hatten ausgedehnte Peritonealkarzinome. In 14 von den 20 Patientinnen (70 %) trat das Rezidiv während der Chemotherapie oder innerhalb von sechs Monaten nach dem Ende der Chemotherapie auf. Dreizehn Patientinnen (65 %) hatten malignen Aszites präoperativ, während die übrigen sieben Patientinnen (35 %) positive peritoneale Spülungen aufwiesen.
Ergebnisse: Während der Operation und der CIIPHCP traten keine Komplikationen auf. Das Aszites-freie Intervall betrug 21 Monate (3-109). Die mediane Überlebenszeit für Patientinnen mit Tumorrest weniger als 1,5 cm war 29,0 Monate, wobei für Patientinnen mit Tumorrest gleich oder größer als 1,5 cm die mediane Überlebenszeit 7,0 Monate betrug. Dieser Unterschied war statistisch signifikant (P < 0,05).
Schlussfolgerungen: Die Überlebensdaten unserer Patientinnen und das postoperative Verschwinden des malignen Aszites deutet an, dass die kontinuierliche intraoperative intraperitoneale hyperthermische Chemoperfusion eine effektive therapeutische Option für Patientinnen mit rezidivierenden Ovarialkarzinomen darstellt.

Key words

Recurrent ovarian cancer - cytoreduction - intraperitoneal chemoperfusion - hyperthermia

Schlüsselwörter

Rezidivierendes Ovarialkarzinom - Tumorreduktion - intraperitoneale Chemoperfusion - Hyperthermie

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