மூலக்கூறு மற்றும் மரபணு மருத்துவம்

Secondary Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS+HIPEC) for Recurrent Epithelial Ovarian Cancer (EOC): Indian Experience

Abstract

Somashekhar SP, Prasanna G, Rajshekhar Jaka, Amit Rauthan, Murthy HS and Sunil Karanth

Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) has been proposed as treatment for recurrent epithelial ovarian carcinoma. We evaluated the outcomes of CRS +HIPEC in recurrent epithelial ovarian cancers, in Indian patients.

Method: In this prospective non-randomized study between February 2013 and January 2015, 26 patients with advanced recurrent EOC, with no extra-abdominal disease treated with secondary CRS+HIPEC in a tertiary care cancer institution, Southern India, were analyzed. Belmonte® hyperthermia (HIPEC) pump with cisplatin 100 mg/m2, 41.5°C to 43°C for 90 minutes, in platinum sensitive cases and doxorubicin 15 mgs/m2 + cisplatin 75 mg/m2 in platinum resistant cases was used.

Result: Among twenty six patients 18 were upfront and 8 were post chemotherapy. Median peritoneal carcinomatosis Index was 9.5 (Range: 3-19). The extent of cytoreduction associated with longer hospital stay (p < 0.001), delayed gastrointestinal recovery (p=0.039), infections (p=0.036), and Acute Respiratory Distress Syndrome (p=0.041). Completeness of cytoreduction score CC0 achieved in 24 and CC1 in 2 patients. Bowel resection required in 34.6%. Diaphragm stripping was required in 30.7% with resection in 7.6%. Median hospital stay was 12 days (range: 10-42 days). No 30 days mortality. Bowel fistula happened in 7.6% cases requiring re-exploration, temporary stomas, and wound related complications in 26%. At median follow-up of eighteen months, 11.5% recurrences (both platinum resistant cases recurred in peritoneal cavity and one patient also in liver parenchyma) and one platinum sensitive patient recurred isolated in peritoneal cavity. One patient died at 5th month of follow up due to pulmonary embolism.

Conclusion: In our Indian study, secondary CRS+HIPEC are shown to be very promising in recurrent epithelial ovarian cancers patients with no extra-abdominal disease and good performance status. And can be done with acceptable morbidity, using dedicated HIPEC machine resulting in good peritoneal control of disease and disease free survival.