A Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy in Primary Advanced Ovarian Cancer: The First Reported Pilot Experience from Saudi Arabia.

BACKGROUND

Around two thirds of patients with ovarian cancer present to clinical attention with advanced-stage disease in the form of peritoneal carcinomatosis (PC) or distant metastasis, which is correlated with a poor fiveyear overall survival (OS) of less than 20%. The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery (CRS) has been depicted to offer survival benefits in patients with PC arising from primary advanced ovarian cancer. However, no similar study was conducted from Saudi Arabia, specifically, or the Gulf region, generally. The primary aim of this study is to describe our pilot single-institutional experience (feasibility, safety and survival outcomes) with CRS plus HIPEC in managing PC arising from primary advanced ovarian cancer..

MATERIAL AND METHOD

A retrospective cross-sectional study was conducted at Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. From January 2016 to July 2019, the medical records of 16 eligible patients were reviewed for clinical, perioperative and survival data. Survival analyses of DFS were calculated according to the Kaplan-Meier estimates method and compared by using two-tailed log-rank test. Statistical significance was regarded as a p value < 0.05.

RESULTS

Cytoreduction completeness CC-0 (optimal) and CC-1 (suboptimal) were achieved in 10 (63%) and six (37%) patients, respectively. The median peritoneal cancer index (PCI) score was 11 (range: 6-18). Nine patients (56%) received combination cisplatin (50 mg/m2) plus doxorubicin (15 mg/m2) as HIPEC regimen whereas the remaining seven patients (44%) received intense single-agent cisplatin (100 mg/m2). No intraoperative morbidity or mortality occurred. Four patients (25%) developed grade III-IV postoperative adverse events based on the Clavien-Dindo surgical complications; no patient developed HIPEC-related renal or hematological toxicities. The median hospital stay was 13 days (range: 11-40). The median follow-up time was 16 months (range: 7-43). The mean OS and DFS were 38.7 months (95% confidence interval [CI]: 31.7-45.6) and 28.4 months (95% CI: 20.7-36.0), respectively. Eleven patients were alive and disease-free (69%). Disease recurrence occurred in five patients (31%). One patient died 30 months after CRS plus HIPEC due to distant brain metastasis. Univariate analysis of parameters related to DFS showed that advanced stage IV disease (p = 0.01), suboptimal CC-1 cytoreduction completeness (p = 0.01) and >11 high PCI score (p = 0.03) were independent factors associated with statistically significant poor DFS.

CONCLUSION

CRS plus HIPEC is technically feasible, largely morbid-free and correlates with enhanced survival outcomes in patients with primary advanced ovarian cancer.