Tertiary cytoreduction for recurrence of ovarian CANCER patients after intraperitoneal chemotherapy

This study evaluated the feasibility, complications, and outcomes of a tertiary cytoreduction after second-line treatment with IP (intraperitoneal) versus IV (intravenous) chemotherapy in recurrent ovarian cancer (ROC) patients.

We retrospectively collected data of patients treated with an optimal tertiary cytoreduction. At the second relapse, the patients underwent optimal secondary surgery followed by IP chemotherapy (case group) or by IV chemotherapy (control group). Differences in treatment-related morbidity rate, pattern of recurrence, and oncologic outcomes were evaluated by Mann-Whitney and Chi-Squared. Kaplan-Meier and frailty model for recurrent events were used to assess statistical significance in differences of disease-free survival.

Charts of 60 patients with a second ROC were identified. The patients with extensive peritoneal carcinomatosis or an inaccessible abdominal cavity were excluded. Twenty-nine patients (48.3%) who underwent optimal tertiary cytoreduction were included: 16 and 13 patients were from the IP and IV groups, respectively. At the second relapse, 56.2% of patients in the IP group and 61.5% in the IV group presented oligometastatic disease, respectively. The adhesions were significantly more represented in the IP group than the IV group (p = 0.01). Days to the first flatus were significantly different in the two groups (4.2 in IP group and 2.5 days in IV group, p < 0.01).

The present study showed that IP chemotherapy does not represent an obstacle to surgery in ROC patients. The surgery after IP is feasible. No significant differences in terms of complications and outcomes were observed in the two groups.