Daniele Biacchi1, Fabio Accarpio1, Luca Ansaloni2, Antonio Macrì3, Antonio Ciardi4, Orietta Federici5, Alessandra Spagnoli6, Davide Cavaliere7, Marco Vaira8, Paolo Sapienza9, Paolo Sammartino1. 1. Cytoreductive Surgery and HIPEC Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy. 2. Department of Surgery, General and Emergency Surgery Unit Bufalini Hospital, Cesena, Italy. 3. Department of Surgery, Peritoneal Surface Malignancy and Soft Tissue Sarcoma Program, University of Messina, Italy. 4. Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy. 5. Department of Surgery, Surgical Oncology National Cancer Institute Regina Elena, Rome, Italy. 6. Department of Public Health and Infection Disease, Statistics Section, Sapienza University of Rome, Rome, Italy. 7. Department of General Surgery and Advanced Oncologic Therapies Unit, AUSL della Romagna, Forlì, Italy. 8. Department of Surgical Oncology, Candiolo Institute for Cancer Research and Treatment, Torino, Italy. 9. Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy.
Abstract
BACKGROUND: Whether patients with advanced tubo-ovarian high-grade serous cancer (HGSC) fare better after upfront debulking surgery (UDS) or neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) remains controversial. METHODS: We studied patients with HGSC who underwent UDS or NACT-IDS between July 2000 and December 2015, with peritonectomy procedures combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Clinical reports were included peritoneal cancer index (PCI), NACT responses, surgical complexity score (SCS), completeness of cytoreduction (CC), complete follow-up with timing, site, and treatment of recurrence. Outcome measures were morbidity, progression-free survival (PFS), PFS2, and overall survival during a mean 5-year follow-up. RESULTS: A total of 34 patients (23.6%) underwent UDS and 110 (76.4%) NACT-IDS both combined with HIPEC. At a median 66.3-month follow-up, patients who underwent UDS or NACT-IDS had similar outcomes. NACT subgroup responses correlated with PCI, SCS, morbidity, and CC. Patients who underwent UDS had lower recurrence rates than those who responded partly or poorly to NACT (PFS, P < .04; PFS2, P < .01). Despite HIPEC, the peritoneal disease recurred in 42.5% of the overall patients. CONCLUSION: In patients with primary HGSC who undergo UDS or NACT-IDS, despite similar outcomes, peritonectomy procedures combined with HIPEC seem unable to prevent peritoneal recurrence.
BACKGROUND: Whether patients with advanced tubo-ovarian high-grade serous cancer (HGSC) fare better after upfront debulking surgery (UDS) or neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) remains controversial. METHODS: We studied patients with HGSC who underwent UDS or NACT-IDS between July 2000 and December 2015, with peritonectomy procedures combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Clinical reports were included peritoneal cancer index (PCI), NACT responses, surgical complexity score (SCS), completeness of cytoreduction (CC), complete follow-up with timing, site, and treatment of recurrence. Outcome measures were morbidity, progression-free survival (PFS), PFS2, and overall survival during a mean 5-year follow-up. RESULTS: A total of 34 patients (23.6%) underwent UDS and 110 (76.4%) NACT-IDS both combined with HIPEC. At a median 66.3-month follow-up, patients who underwent UDS or NACT-IDS had similar outcomes. NACT subgroup responses correlated with PCI, SCS, morbidity, and CC. Patients who underwent UDS had lower recurrence rates than those who responded partly or poorly to NACT (PFS, P < .04; PFS2, P < .01). Despite HIPEC, the peritoneal disease recurred in 42.5% of the overall patients. CONCLUSION: In patients with primary HGSC who undergo UDS or NACT-IDS, despite similar outcomes, peritonectomy procedures combined with HIPEC seem unable to prevent peritoneal recurrence.
Authors: Orestis Tsonis; Fani Gkrozou; Konstantinos Vlachos; Minas Paschopoulos; Michail C Mitsis; Nikolaos Zakynthinakis-Kyriakou; Stergios Boussios; George Pappas-Gogos Journal: Ann Transl Med Date: 2020-12