In women with metastatic ovarian cancer restricted to the abdominal cavity (stage III), hyperthermic intraperitoneal chemotherapy (HIPEC) improves survival with almost no additional side effects, according to research published in the New England Journal of Medicine.
The research, led by the Netherlands Cancer Institute in collaboration with five other European hospitals, involved 245 patients.
In the intention-to-treat analysis, disease recurrence or death occurred in 89% of women who underwent cytoreductive surgery without HIPEC (surgery group) and in 81% who underwent cytoreductive surgery with HIPEC (surgery-plus-HIPEC group) (hazard ratio [HR] for disease recurrence or death, 0.66; 95% confidence interval [CI], 0.50–0.87; P = 0.003). The median recurrence-free survival was 10.7 months in the surgery group and 14.2 months in the surgery-plus-HIPEC group.
At a median follow-up of 4.7 years, 76 patients (62%) in the surgery group and 61 patients (50%) in the surgery-plus-HIPEC group had died (HR, 0.67; 95% CI, 0.48–0.94; P = 0.02). The median overall survival was 33.9 months in the surgery group and 45.7 months in the surgery-plus-HIPEC group. The percentage of patients who had adverse events of grade 3 or 4 was similar in the groups (25% in the surgery group and 27% in the surgery-plus-HIPEC group).
Ovarian cancer is the gynecological malignancy with the highest mortality worldwide. In about 75% of cases, the disease has already metastasized in the abdomen when diagnosed. The standard treatment, in this case, consists of a comprehensive operation in combination with chemotherapy. There are two treatment strategies: the patient either starts with an operation followed by six courses of chemotherapy (primary debulking) or is given three chemotherapy courses before and three after the operation (interval debulking). With this treatment, about a third of the patients are still alive after five years.
In this study, between 2007 and 2016 half of the women with stage III ovarian carcinoma who were treated with an interval debulking received the new HIPEC treatment, which involves abdominal lavage (washing out the abdominal cavity) with heated chemotherapy. Prior to the operation, all of the women were given three rounds of chemotherapy. Women for whom the gynecologist was able to remove virtually all of the tumors during surgery were eligible for the study. A drawing of lots determined who got the abdominal lavage and who did not. The abdominal lavage was applied at the end of surgery. After surgery, all of the women were given three more rounds of chemotherapy.