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HIPEC after neoadjuvant chemotherapy is associated with acceptable toxicity and favorable quality of life in newly diagnosed advanced ovarian cancer patients

  • Anya V. Menzies
    Correspondence
    Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Medical Center Blvd, Winston Salem, NC 27157, United States of America.
    Affiliations
    Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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  • Erik C. Usher
    Affiliations
    Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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  • Fang-Chi Hsu
    Affiliations
    Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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  • Edward A. Levine
    Affiliations
    Department of Surgical Oncology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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  • Samuel S. Lentz
    Affiliations
    Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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  • Michael G. Kelly
    Affiliations
    Department of Obstetrics and Gynecology, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
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Published:September 06, 2022DOI:https://doi.org/10.1016/j.ygyno.2022.08.015

      Highlights

      • Hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with advanced ovarian cancer has many biological advantages.
      • Intraperitoneal carboplatin is an alternative to cisplatin for HIPEC at the time of cytoreductive surgery.
      • The use of carboplatin was feasible and well-tolerated by patients. There was no difference in quality of life outcomes.

      Abstract

      Objective

      To evaluate toxicity, quality of life and PFS in patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy (NAC) followed by CRS and HIPEC with carboplatin.

      Methods

      Patients with stage IIIC or IVA epithelial ovarian cancer, who were not candidates for primary CRS, were enrolled in this phase two trial. Patients received 3–6 cycles of NAC with an IV carboplatin doublet followed by CRS with HIPEC (carboplatin 800 mg/m2 for 90 min). They were followed for at least 12 months to assess for adverse events, quality of life (QOL) and disease progression. QOL was measured using the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaires prior to CRS and post-operatively at 6 weeks, 3 months, and 6 months after CRS.

      Results

      Twenty patients were enrolled. HIPEC was completed successfully in all twenty patients, and there was no peri-operative mortality. Twelve (70.6%) patients experienced a grade 3 or 4 toxicity; most commonly anemia (59%), thrombocytopenia (29%), and hypokalemia (24%). There was no significant change between the pre-operative and postoperative 6 weeks, 3 month, and 6 month FACT-O, NTX, and AD scores. Nine (45%) patients have experienced disease recurrence to date. The median progression free survival in this cohort is 11.2 months (2.5–23.7 months).

      Conclusion

      The addition of HIPEC with carboplatin to interval CRS was well tolerated in patient population. Myelosuppression was the most common adverse event. CRS with HIPEC did not adversely impact these patients' QOL indices. The efficacy of this regimen should be further evaluated in a larger clinical trial.

      Keywords

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