Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer : A Multicentric Propensity Score Study
Llueca, Antoni (Department of Medicine, University Jaume I)
Ibañez, Maria Victoria (Department of Mathematics, University Jaume I)
Cascales, Pedro (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Gil-Moreno, Antonio 1965- (Vall d'Hebron Institut d'Oncologia)
Bebia, Vicente (Vall d'Hebron Institut d'Oncologia)
Ponce, Jordi (Hospital Universitari de Bellvitge)
Fernández-González, Sergi (Hospital Universitari de Bellvitge)
Arjona-Sanchez, Alvaro (University Hospital Reina Sofia)
Muruzabal, Juan Carlos (Department of Gynecologic Oncology, Complejo Hospitalario de Navarra)
Veiga, Nadia (Department of Gynecologic Oncology, Complejo Hospitalario de Navarra)
Díaz-Feijoo, Berta (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Celada, Cristina (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Gilabert-Estelles, Juan (Department of Obstetrics and Gynecology, University General Hospital of Valencia)
Aghababyan, Cristina (Department of Obstetrics and Gynecology, University General Hospital of Valencia)
Lacueva, Javier (Department of General Surgery, University General Hospital of Elche)
Calero, Alicia (Department of General Surgery, University General Hospital of Elche)
Segura-Sampedro, Juan José (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Maiocchi, Karina (Department of General Surgery, University General Hospital of Castellon)
Llorca, Sara (Department of General Surgery, University General Hospital of Castellon)
Villarin, Alvaro (Department of General Surgery, University General Hospital of Castellon)
Climent, Maria Teresa (Department of Medicine, University Jaume I)
Delgado, Katty (Department of Medicine, University Jaume I)
Serra Rubert, Anna (Department of Medicine, University Jaume I)
Gomez-Quiles, Luis (Department of General Surgery, University General Hospital of Castellon)
Llueca, Maria (Hospital Universitari Joan XXIII de Tarragona)
Universitat Autònoma de Barcelona

Date:	2023
Abstract:	Advanced ovarian cancer (Stages III-IV) continues to be one of the gynecological tumors with the highest mortality. Standard treatment consists of debulking surgery and subsequent adjuvant chemotherapy. Recently, some authors have postulated that the administration of hyperthermic chemotherapy during surgery could increase the survival of patients, especially in cases in which chemotherapy had already been administered before surgery to reduce tumor volume. Our study is important because it collects data from 11 tertiary hospitals in Spain, and the data are subjected to a statistical technique that reproduces the data that we would find in a prospective study but using retrospective data (propensity score matching). It also offers a current view of the status of ovarian cancer treatment in our country. Introduction: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). Materials and Methods: A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. Results: A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79. 4% vs. 84. 7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0. 74; 95% CI, 0. 58-0. 94; p = 0. 031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0. 88; 95% CI, 0. 64-1. 20; p = 0. 44). There was no increase in complications in the CRSH group. Conclusion: The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
Note:	Funding: This work received financial support from the Medtronic University Chair for Training and Surgical Research, University Jaume I (UJI), Castellon, Spain
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Hyperthermic intraperitoneal chemotherapy ; Advanced ovarian cancer ; Neoadjuvant chemotherapy ; Complete surgery ; Prgresion free survival ; Overall survival
Published in:	Cancers, Vol. 15 (august 2023) , ISSN 2072-6694

DOI: 10.3390/cancers15174271
PMID: 37686547

18 p, 3.7 MB

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