Neoadjuvant Bi-Directional Chemotherapy with PIPAC and Systemic Chemotherapy in Advanced Epithelial Ovarian Cancer:...

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Chemotherapy Delivery Systems

Background:

• Advanced epithelial ovarian cancer often presents as unresectable despite neoadjuvant chemotherapy.
• Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) offers a potential strategy to improve locoregional response when combined with systemic treatments.

Purpose of the Study:

• To evaluate the safety, feasibility, and surgical conversion potential of neoadjuvant bidirectional chemotherapy incorporating PIPAC in patients with initially unresectable advanced ovarian cancer.

Main Methods:

• A single-center retrospective study of 45 patients with FIGO stage IIIC-IVA ovarian cancer receiving platinum-taxane neoadjuvant chemotherapy.
• Unresectable patients received bidirectional chemotherapy: systemic platinum-based therapy plus PIPAC.
• Primary outcomes: safety and conversion to complete cytoreductive surgery (CRS) with HIPEC; secondary outcomes: response rates and perioperative morbidity.

Main Results:

• 62.2% of patients achieved sufficient response for conversion to CRS with HIPEC after bidirectional therapy.
• Favorable histological and radiological responses were observed in 44.4% and 53.4% of patients, respectively.
• The procedure demonstrated acceptable safety, with low rates of major morbidity and no 30-day mortality, facilitating high rates of complete tumor resection (CC-0) during subsequent surgery.

Conclusions:

• Neoadjuvant bidirectional chemotherapy combining PIPAC with systemic chemotherapy is a safe and feasible approach for selected patients with advanced ovarian cancer.
• This strategy facilitates surgical conversion, suggesting potential for improved outcomes.
• Further prospective studies are needed to confirm long-term survival benefits.