Sp Somashekhar, C Rohit Kumar, Kr Ashwin, Y Ramya, N Arun Kumar, Fernandez Aaron Marian, Ahuja Vijay
Aster International Institute Of Oncology, Aster Hospitals, Bengaluru, India.
Apollo Hospitals, Mysuru, India.
J Surg Oncol. 2024 Nov;130(6):1358-1363. doi: 10.1002/jso.27896. Epub 2024 Sep 30.
The impact of delay in initiation of adjuvant chemotherapy following optimal CRS in different settings of treatment for advanced ovarian cancer needs to be studied with special reference to CRS HIPEC.
The 1480 advanced EOC patients underwent optimal CRS, followed by adjuvant chemotheraphy, with or without intraperitoneal (IP) chemotherapy in Normothermic or Hyperthermic form. Interval between the day of surgery and start of adjuvant chemotherapy and its impact on outcome was analyzed.
CRS, CRS with IP or HIPEC was done in 400, 480, and 600 patients respectively. Median interval of starting adjuvant chemotherapy was 32 days CRS group, 34 days CRS + IP group and 41 days CRS + HIPEC group. Delay in chemotherapy impacted on recurrence free survival (RFS) in CRS + IV group (36 vs. 17 months: p = 0.02) and some impact in CRS + IP group (38 vs. 28 months; P 0.78) and no impact on CRS + HIPEC group (35 vs. 32 months; p = 0.17).
Delay in starting adjuvant chemotherapy adversely affects RFS in patients undergoing optimal CRS alone. However, the delay didn't have an impact in the CRS + HIPEC group. Well-designed clinical studies are required to evaluate the impact of single dose of HIPEC.
在晚期卵巢癌不同治疗背景下，尤其对于细胞减灭术联合腹腔热灌注化疗（CRS HIPEC），需要研究在最佳细胞减灭术后延迟启动辅助化疗的影响。
1480例晚期上皮性卵巢癌患者接受了最佳细胞减灭术，随后进行辅助化疗，化疗采用或不采用常温或热灌注形式的腹腔内（IP）化疗。分析手术日与辅助化疗开始日之间的间隔及其对预后的影响。
分别有400例、480例和600例患者接受了细胞减灭术、细胞减灭术联合IP化疗或CRS HIPEC。辅助化疗开始的中位间隔时间在细胞减灭术组为32天，细胞减灭术联合IP化疗组为34天，细胞减灭术联合HIPEC组为41天。化疗延迟对细胞减灭术联合静脉化疗组的无复发生存期（RFS）有影响（36个月对17个月：p = 0.02），对细胞减灭术联合IP化疗组有一定影响（38个月对28个月；P = 0.78），对细胞减灭术联合HIPEC组无影响（35个月对32个月；p = 0.17）。
对于仅接受最佳细胞减灭术的患者，延迟启动辅助化疗会对RFS产生不利影响。然而，延迟在细胞减灭术联合HIPEC组中没有影响。需要设计完善的临床研究来评估单剂量HIPEC的影响。
