Critical Analysis of Stage IV Epithelial Ovarian Cancer Patients after Treatment with Neoadjuvant Chemotherapy followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRSHIPEC)‎

الملخص EN

Background.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) after neoadjuvant chemotherapy (NACT) showed promise as initial treatment for stage IIIC (SIII) epithelial ovarian cancer (EOC); however, stage IV (SIV) outcomes are rarely reported.

We assessed our experience and outcomes treating newly diagnosed SIV EOC with NACT plus CRS/HIPEC compared to SIII patients.

Methods.

Advanced EOC from 2015–2018 managed with NACT (carboplatin/paclitaxel) due to unresectable disease or poor performance status followed by interval CRS/HIPEC were reviewed.

Perioperative factors were assessed.

Overall survival (OS) and progression-free survival (PFS) were analyzed by stage.

Results.

Twenty-seven FIGO stage IIIC (n = 12) and IV (n = 15) patients were reviewed.

Median NACT cycles were 3 and 4, respectively.

Post-NACT omental caking, ascites, and pleural effusions decreased/resolved in 91%, 91%, and 100% of SIII and 85%, 92%, and 71% of SIV.

SIII/SIV median PCI was 21 and 20 obtaining 92% and 100% complete cytoreduction (≤0.25 cm), respectively.

Median organ resections were 6 and 7, respectively.

Grade III/IV surgical complications were 0% SIII and 23% SIV, without hospital mortality.

Median time to adjuvant chemotherapy was 53 and 74 days, respectively (p=0.007).

SIII OS at 1 and 2 years was 100% and 83% and 87% and 76% in SIV (p=0.269).

SIII 1-year PFS was 54%; median PFS: 12 months.

SIV 1- and 2- year PFS was 47% and 23%; median PFS: 12 months (p=0.944).

Conclusion.

Outcomes in select initially diagnosed and unresectable SIV EOC are similar to SIII after NACT plus CRS/HIPEC.

SIV EOC may benefit from CRS/HIPEC, and further studies should explore this treatment approach.