Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.167
Revised: April 23, 2013
Accepted: July 9, 2013
Published online: November 10, 2013
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 modified 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 chemotherapy.
RESULTS: 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 up.
CONCLUSION: 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.
Core tip: This is a report of a phase 2 prospective observational study, which served as a pilot study for the CHORINE trial protocol (http://www.chorine.org). Our pilot study supports the feasibility of neoadjuvant chemotherapy (NACT) followed by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for upfront treatment of advanced epithelial ovarian cancer. This combined therapy does not reduce the possibility to start the postoperative systemic chemotherapy in an acceptable period of time. We believe that in the upfront setting NACT can better select chemoresponsive patients, increasing their chance to take advantage from HIPEC, reducing the surgical stress and the perioperative complications.