Brief Article
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World J Obstet Gynecol. Nov 10, 2013; 2(4): 167-175
Published online Nov 10, 2013. doi: 10.5317/wjog.v2.i4.167
Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer
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
Marco Lotti, Luca Campanati, Federico Coccolini, Michele Pisano, Elia Poiasina, Diego Rossetti, Paolo Bertoli, Luca Ansaloni, Unit of General Surgery 1, Papa Giovanni XXIII Hospital, 24128 Bergamo, Italy
Luisa Maria Busci, Giuseppe Grosso, Diego Rossetti, Luigi Frigerio, Unit of Gynecology and Obstetrics, Papa Giovanni XXIII Hospital, 24128 Bergamo, Italy
Fausto Catena, Giorgio Ercolani, Antonio Daniele Pinna, Unit of General Surgery, St.Orsola-Malpighi University Hospital, 40138 Bologna, Italy
Naoual Bakrin, Department of Gynecology, Lyon Sud Hospital, 69310 Pierre Benite, France
Pierandrea De Iaco, Martina Rossi, Unit of Gynecology and Obstetrics, St.Orsola-Malpighi University Hospital, V40138 Bologna, Italy
Claudio Zamagni, Medical Oncology, St.Orsola-Malpighi University Hospital, 40138 Bologna, Italy
Author contributions: Lotti M and Ansaloni L designed the study protocol and wrote the article; Busci LM, Catena F, Campanati L, Coccolini F, Bakrin N, De Iaco P, Ercolani G, Grosso G, Pisano M, Poiasina E, Rossetti D, Rossi M, Zamagni C, Bertoli P, Pinna AD and Frigerio L were involved in patients’ recruitment, treatment and in providing data for analysis.
Correspondence to: Dr. Luca Ansaloni, MD, Unit of General Surgery 1, Papa Giovanni XXIII Hospital, Piazza OMS, Organizzazione mondiale della sanità 1, 24128 Bergamo, Italy. lansaloni@hpg23.it
Telephone: +39-3-5269310 Fax: +39-3-5266898
Received: February 21, 2013
Revised: April 23, 2013
Accepted: July 9, 2013
Published online: November 10, 2013
Processing time: 269 Days and 19.4 Hours
Abstract

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.

Keywords: Peritoneal carcinomatosis; Ovarian cancer; Cytoreductive surgery; Intraperitoneal chemotherapy; Hyperthermic intraperitoneal chemotherapy; Hyperthermia

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.