MD News - HIPEC: Furthering Survivorship for GYN Cancer Patients

MD News - HIPEC: Furthering Survivorship for GYN Cancer Patients

Monday, March 12, 2012

A team of cancer specialists at the Seidman Cancer Center at University Hospitals (UH) Case Medical Center is among the first in the nation to launch a dedicated gynecologic program using Hyperthermic Intraperitoneal Chemotherapy (HIPEC) to treat ovarian, endometrial and select other malignancies.

 Q: What is HIPEC, and how is it delivered?
Q: What are the advantages of HIPEC over traditional IV chemotherapy?
Q: I understand UH is planning several research studies on HIPEC. What will they involve?
Q: What do you want physicians to know about HIPEC?
   

(HIPEC) Targeted treatment for ovarian cancer to be studied at University Hospitals (this spring) | cleveland.com

"The studies, which physicians hope to begin this spring, have been designed for a very specific patient population -- no more than a couple dozen women with ovarian or endometrial cancer will be enrolled in each one....."

"Here are the Phase 1 trials:

• A study involving the use of heated chemotherapy for ovarian cancer that has spread to the chest. What the surgical team has dubbed HITEC (the "T" coming from the word intrathoracic) is performed after minimally invasive lung surgery. "To my knowledge, no one has treated ovarian cancer [that has spread to] the chest like this," DeBernardo said.

• A study for advanced ovarian-cancer patients whose cancer is in remission following surgery and chemotherapy. The patients will undergo HIPEC to prevent recurrence.

• A study for patients whose cancer recurs; HIPEC will be performed following surgery.

• A study for patients who undergo chemotherapy prior to (neoadjuvant) surgery and HIPEC during the surgery.

open access: Cytoreductive Surgery Combined with Hyperthermic Intraperitoneal Intraoperative Chemotherapy in the Treatment of Advanced Epithelial Ovarian Cancer

 Background/Aims.
Intraperitoneal intraoperative hyperthermic chemotherapy (HIPEC) has been used in the treatment of ovarian cancer. The purpose of the study is to determine the efficacy of HIPEC after cytoreductive surgery in advanced ovarian cancer

 From 2006 to 2010, 43 women with primary or recurrent ovarian cancer were enrolled in the study and underwent maximal cytoreductive surgery and HIPEC. The mean age of the patients was 59.9 yrs (16–82) years.

Table 1: Characteristics of the patients.

Table 2: Peritonectomy procedures.

Table 3: Complications ( 6 grade 111/1V events)
"...Severe morbidity (grade 3 and 4) has been recorded in 6 patients (14%). It is obvious that the most severe complication is the anastomotic failure. Anastomotic failure has been reported in other series as the most frequent complication [8, 9, 25]. Cisplatin has been incriminated to impair anastomotic healing in animal studies [26] in contrast to local hyperthermia that has not [27]. As a consequence, the failures may be attributed either to cisplatin or to the immediate restoration of the gastrointestinal tract after low-anterior resection particularly in those cases with preoperative partial intestinal obstruction. The importance of intestinal obstruction and the avoidance of immediate restoration of the gastrointestinal tract has been emphasized [9] resulting in significant decrease of anastomotic failures [28]. Therefore a protective colostomy seems to be a reasonable solution. Other severe complications as intra-abdominal abscess or sepsis or postoperative bleeding are infrequent [8, 9, 25]....."


Conclusions
Maximal cytoreductive surgery with standard peritonectomy procedures combined with intraperitoneal chemotherapy is a well-tolerated and feasible method for treatment of advanced epithelial ovarian cancer. It appears to improve long-term survival securing that complete or near complete cytoreduction is possible in the vast majority as well as the eradication of the microscopic residual tumor.

abstract: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: Multi-institutional phase-II trial

Conclusions.

In selected patients with advanced stage EOC, upfront CRS and HIPEC provided promising results in terms of outcome. Morbidity was comparable to aggressive cytoreduction without HIPEC. Postoperative recovery delayed the initiation of adjuvant systemic chemotherapy but not sufficiently to impact negatively on survival. These data warrant further evaluation in a randomized clinical trial.

Highlights

► Maximal surgical effort and intraperitoneal chemotherapy have been proposed as upfront treatment in epithelial ovarian cancer.
► Primary cytoreduction and hyperthermic intraperitoneal chemotherapy was performed in advanced epithelial ovarian cancer patients.
► Promising survival rates and acceptable morbidity were reported.

abstract: Reappraisal of the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of ovarian cancer: a single institutional experience.

abstract: HIPEC (hyperthermic intraoperative intraperitoneal chemotherapy) in recurrent ovarian cancer patients: Morbidity-related treatment and long-term analysis of clinical outcome.

abstract: Indication for oophorectomy during cytoreduction for intraperitoneal metastatic spread of colorectal or appendiceal origin(cytoreductive surgery/HIPEC)

BACKGROUND: The incidence of ovarian metastases at the time of peritoneal carcinomatosis, and the influence of such metastases on survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), are unknown.
METHODS: This retrospective analysis included 194 women subjected to CRS and HIPEC since 2001. The incidence of ovarian metastases, disease-free survival and disease-specific survival were analysed.
RESULTS: The histological diagnosis was colorectal cancer carcinomatosis in 108 patients, peritoneal mucinous carcinomatosis (PMCA) in 23 and disseminated peritoneal adenomucinosis (DPAM) in 63. Ninety-nine patients underwent oophorectomy during the HIPEC procedure. Ovarian metastases were confirmed in at least 52 per cent of the patients. There was a significant difference in disease-free survival between women with or without ovarian metastases in both PMCA and DPAM groups (P = 0·044 and P = 0·010 respectively). No significant differences in survival were found in the group with colorectal cancer carcinomatosis.
CONCLUSION: When peritoneal carcinomatosis of colorectal or appendiceal origin is confirmed, at least 52 per cent of ovaries will have synchronous metastases. Disease-free survival after a HIPEC procedure for PMCA or DPAM is significantly lower in women with ovarian metastases. Oophorectomy during CRS for peritoneal carcinomatosis should be strongly considered.

Continued Uncertainty Regarding Hyperthermic Intraperitoneal Chemotherapy in Malignant Peritoneal Mesothelioma -- Markman 28 (24): e418 -- Journal of Clinical Oncology

Gastric perforation following cytoreductive surgery with perioperative intraperitoneal chemotherapy HIPEC

Peritoneal-based Malignancies and Their Treatment. [Ann Acad Med Singapore. 2010] - PubMed result

Conclusion: It is important to recognise the role of and indications for CRS and HIPEC