Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer: State of the art

Table 1 Cytoreductive surgery + hyperthermic intraperitoneal chemotherapy in the treatment of advanced stage primary epithelial ovarian cancer: retrospective and observational studies: Study characteristics

Ref.	n	Disease stage	Setting of treatment	HIPEC drug and dose	Temp. (°C)	Duration of treatment (min)	Oncologic outcome	Common grade 2-3 toxicities	Mortality rate
Tentes et al[8]	43	“Locally advanced” ovarian cancer	23 primary	Doxorubicin 15 mg/m2 + Cisplatin 50 mg/m2 or Gemcitabine 1000 mg/m2	42.5-43	60 or 90	5-yr OS: 54%	Hematologic; GI; infectious	2 deaths (sepsis)
			20 recurrent				In primary population 5-yr OS 82.5%
Steller et al[31]	6	2-3 EOC	2 primary	Carboplatin 800-1200 mg/m2	42	90	All alive at 15 mo follow up; 5 without evidence of disease	Hematologic	No deaths
			4 recurrent
Piso et al[33]	19	3-4 EOC	8 primary	Cisplatin 75 mg/m2 + Mitoxantrone 15 mg/m2	41.5	90	Median PFS 18 mo; mean OS 33 mo; 5 yr survival 15%	Hematologic; GI (anastomotic leak, fistula); bleeding; abscess	1 death (sepsis)
			11 recurrent
Rufián et al[35]	33	3 EOC	19 primary	Paclitaxel 60 mg/m2	41-43	60	In primary population median relapse free survival was 25 mo; median OS 38 mo	Hematologic; infectious; GI (bleeding and perforation)	No deaths
			14 recurrent
Lentz et al[37]	25	3 EOC	11 primary	Carboplatin 400-1200 mg/m2	Inflow < 43.5	90	Not reported	One PE; one superficial wound dehiscence	No deaths
			14 recurrent
Pavlov et al[39]	56	3-4 EOC	31 primary	Doxorubicin 0.1 mg/kg + Cisplatin 15 mg/m2	40	180	Median OS 38.1 mo; 5-yr OS 67%	Hematologic; GI (anastomotic leak, obstruction)	1 death (CVA)
			25 recurrent

HIPEC: Hyperthermic intraperitonealchemotherapy; Temp.: Temperature; OS: Overall survival; GI: Gastrointestinal; EOC: Epithelial ovarian cancer; PFS: Progression free survival; PE: Pulmonary embolism; CVA: Cerebral-vascular accident.

Table 2 Cytoreductive surgery + hyperthermic intraperitoneal chemotherapy in the treatment of advanced stage primary epithelial ovarian cancer: prospective phase 2 trials

Ref.	n	Disease stage	Setting of treatment	HIPEC drug used and dose	Temp. (°C)	Duration of treatment (min)	OS (mo)	PFS (mo)	Common grade 2-3 toxicities	Mortality rate
Di Giorgio et al[47]	47	3C-4 EOC	22 primary	Cisplatin 75 mg/m2	42-43	60	30.4 (mean)	27.4 (mean)	Pleural effusions (8.5%)	4% (PE)
			25 recurrent						Infectious (8.5%)
									GI (10.6%)
									Bleeding (6.4%)
Lim et al[48]	30	3-4 EOC	30 primary (14 of which underwent neoadjuvant treatment)	Cisplatin 75 mg/m2	41.5	90	NR	NR	Hematologic (86.7%)	No deaths
									GI (30%)
									Infectious (16.7%)
									Pulmonary (23.3%)
									CV (13.3%)
Ansaloni et al[49]	26	3-4 EOC	26 primary	Cisplatin 40 mg/L perfusate + doxorubicin 15 mg/L perfusate	42.5	90	Not reached	30 (median)	Hematologic (4%)	4% (sepsis)
							5-yr OS 60.7%	5-yr PFS 15.2%	GI (4%)
									Pulmonary (14.3%)
									Infectious (14.3%)

Ninety-three percent with complete response to primary treatment. Seven patients with progressive disease. HIPEC: Hyperthermic intraperitonealchemotherapy; Temp.: Temperature; OS: Overall survival; PFS: Progression free survival; EOC: Epithelialovarian cancer; GI: Gastrointestinal; PE: Pulmonary embolism; NR: Not reported; CV: Cardiovascular.