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Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer

World Journal of Obstetrics and Gynecology 2013年第4期2卷 167-175页

作者： Marco Lotti luisa maria busci Luca Campanati Fausto Catena Federico Coccolini Naoual Bakrin Pierandrea De Iaco Giorgio Ercolani Giuseppe Grosso Michele Pisano Elia Poiasina Diego Rossetti Martina Rossi Claudio Zamagni Paolo Bertoli Antonio Daniele Pinna Luigi Frigerio Luca Ansaloni Unit of General Surgery 1 Papa Giovanni XXIII Hospital 24128 Bergamo Italy Unit of Gynecology and Obstetrics Papa Giovanni XXIII Hospital 24128 Bergamo Italy Unit of General Surgery St.Orsola-Malpighi University Hospital 40138 Bologna Italy Department of Gynecology Lyon Sud Hospital69310 Pierre Benite France Unit of Gynecology and Obstetrics St.Orsola-Malpighi University Hospital V40138 Bologna Italy Medical Oncology St.Orsola-Malpighi University Hospital 40138 Bologna Italy

AIM: To reduce postoperative complications and to make possible an optimal cytoreduction, neoadjuvant chemotherapy(NACT) followed by interval debulking surgery has been applied with encouraging results. METHODS: Between December 2009 and February 2012, patients with stage ⅢC-Ⅳ epithelial ovarian cancer(EOC) underwent diagnostic laparoscopy, to assess the feasibility of optimal debulking surgery. The modifi ed Fagotti score was applied to assess the feasibility of resection with zero residual tumor. Patients who were not candidate for upfront debulking surgery were submitted to NACT, then reassessed according to the RECIST 1.1 criteria and submitted to cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) if they showed clinical response or stable disease. The remaining cycles of adjuvant systemic chemotherapy(ASCT) were administered postoperatively, to complete 6 cycles of systemic ***: Nine patients were included. Clinical response to NACT was complete in 3 patients and partial in 5 patients; one patient had stable disease. All patients underwent CRS resulting in CC0 disease prior to HIPEC. Average operative time was 510 min. Average intensive care unit stay was 2 d. Average postoperative hospital stay was 25 d. No postoperative mortality was observed. One patient experienced pelvic abscess. One patient refused ASCT. The remaining 8 patients started ASCT. Average time to chemotherapy was 36 d. All patients are alive, with an average follow up of 11 mo. Eight patients are disease-free at follow ***: HIPEC after CRS for advanced EOC is feasible with acceptable morbidity and mortality. NACT may increase the chance for achieving complete cytoreduction. Phase 3 studies are needed to determine the effects of HIPEC on survival.

关键词： Peritoneal carcinomatosis Ovarian cancer Cytoreductive surgery Intraperitoneal chemotherapy Hyperthermic intraperitoneal chemotherapy Hyperthermia

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