An interesting treatment modality being investigated in the setting of recurrent ovarian carcinoma limited to the peritoneal cavity is hyperthermic intraperitoneal chemotherapy (IPHC or HIPEC).45,46 Hyperthermia has been shown to increase the response to cytotoxic agents in human cell lines and animal models.47,48 Small series in optimally cytoreduced recurrent ovarian carcinoma have shown some promise.44,45 However, the infusion must be done over 90 minutes, and therefore the procedure increases operating room times. A mean operating room time of nearly 10 hours was reported by Helm and colleagues.45 The preliminary reported median survivals do not appear to be strikingly better than those seen in Table 10-1. Although this is an
Box 10-4. Factors Predicting Successful Cytoreduction
The probability of achieving no gross residual disease after secondary cytoreduction is higher when the following criteria are met:
• Good performance status
• Complete resection at first operation
• Initial FIGO stage I/II
• No carcinomatosis
• Long treatment-free interval
• Complete response after first-line therapy
• No extra-abdominal metastasis
Box 10-5. Factors Taken into Account in Management of Recurrent Disease
• Extent of recurrence
• Time from previous treatment
• Recurrence number
• Further chemotherapy options
• Patient performance status
Table 10-2. Selection Criteria for Secondary Cytoreduction (SC)
DFI (months) One Site No Carcinomatosis Carcinomatosis
6-12 Offer SC Consider SC No SC
12-30 Offer SC Offer SC Consider SC
>30 Offer SC Offer SC Offer SC
DFI, disease-free interval.
interesting concept, supported in part by preclinical data, the clinical application of this more morbid procedure cannot yet be endorsed without more rigorous investigation in a clinical trial setting.
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