Cytoreductive Surgery With or Without HIPEC After Neoadjuvant Chemotherapy in Ovarian Cancer: A Phase 3 Clinical Trial

• Published in: Annals of surgical oncology 2022-04, Vol.29 (4), p.2617-2625
• Main Authors: Antonio, Cascales Campos Pedro, Alida, González Gil, Elena, Gil Gómez, Rocío, González Sánchez, Jerónimo, Martínez García, Luis, Alonso Romero José, Aníbal, Nieto Díaz, Francisco, Barceló Valcárcel, Jesús, Gómez Ruiz Álvaro, Pablo, Ramírez Romero, José, Gil Martínez
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemotherapy; Cisplatin; Clinical trials; Combined Modality Therapy; Cytoreduction Surgical Procedures - adverse effects; Humans; Hyperthermia, Induced; Hyperthermic Intraperitoneal Chemotherapy; Medicine; Medicine & Public Health; Morbidity; Mortality; Neoadjuvant Therapy; Oncology; Ovarian cancer; Ovarian Neoplasms - pathology; Patients; Peritoneal Neoplasms - therapy; Peritoneal Surface Malignancy; Prospective Studies; Quality of Life; Surgery; Surgical Oncology; Survival; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-11087-7

Background Cytoreductive surgery (CRS) and administration of hyperthermic intraperitoneal chemotherapy (HIPEC) have shown their efficacy in multiple malignancies and also could offer a prognostic benefit for patients with advanced ovarian cancer. Methods A prospective, single-center, parallel-group, randomized phase 3 clinical trial analyzed patients with a diagnosis of carcinomatosis from ovarian cancer treated with neoadjuvant systemic chemotherapy (NACT). In this trial, 71 patients were randomized to receive CRS alone (36 patients) or CRS with HIPEC (35 patients) using cisplatin (75 mg/m 2 for 60 min at 42 °C). The primary end point was disease-free survival (DFS). Overall survival (OS), morbidity, and quality of life (QoL) were the secondary end points. Results During a median follow-up period of 32 months, the median DFS was 12 months in the control group (CRS) and 18 months in the experimental group (CRS and HIPEC). The findings showed HIPEC to be an independent protective factor against the development of recurrence (hazard ratio [HR], 0.12, 95 % confidence interval [CI], 0.02–0.89; p = 0.038). The median OS was 45 months in the control group and 52 months in the experimental group. The respective morbidity rates for any grade (1 to 5) were respectively 58.3 % and 45.7 % ( p > 0.05), with a mortality rates of 2.8 % and 2.9 % ( p > 0.05). In the dimensions evaluated, CRS with or without HIPEC had no impact on QoL. Conclusions For patients who had advanced ovarian cancer treated with NACT, CRS and HIPEC was associated with better DFS and OS, but without a difference in postoperative morbidity, mortality, or in the QoL evaluation.