New Developments in Heated Intraperitoneal Chemotherapy for Gastric and Ovarian Cancer

Surgery with Heated Chemotherapy Versus Surgery Alone for Gastric Cancer with Peritoneal Metastases

Gastric cancer with peritoneal metastasis, medically called peritonitis carcinomatosa, is usually considered end-stage disease. Standard treatment is chemotherapy alone to prolong life and reduce symptoms (palliative), with unsatisfactory outcomes. In peritoneal metastases, cytoreductive surgery , removing all visible tumors, and heated intraperitoneal chemotherapy (HIPEC) have been debated for years. This study assessed effects on survival and other outcomes of combining HIPEC with cytoreductive surgery (removing as much visible abdominal tumor as possible).

Note: Cytoreductive cancer surgery has two outcomes: no visible disease remains (complete cytoreduction), or residual tumor measures 10 mm or less (optimal cytoreduction).

Between 1989 and 2014, at 19 French cancer centers, 277 consecutive gastric cancer patients with peritoneal metastases were assessed. Surgery plus heated chemotherapy in 180 patients was compared with cytoreductive surgery alone in 97.

Survival Was Significantly Longer in the Heated Chemotherapy Group:

• Median overall survival was 19 versus 12 months.
• With heated chemotherapy, 3-year overall survival was 26%, compared with 20% after surgery alone; 5-year survival was 11% versus 6%.
• The 3-year disease-free survival rates were 20% and 17%; 5-year rates were 6% and 4%.
• Treatment-related mortality and side effects, however, were similar.

In conclusion, surgery with heated chemotherapy appears to prolong survival and improve outcomes without extra side effects versus cytoreductive surgery alone for gastric cancer with peritoneal metastases. If complete cytoreduction removes all accessible peritoneal metastases, adding HIPEC could become the new standard at this stage.

Surgery with Heated Chemotherapy Versus Surgery Alone for Stage 3C Ovarian Cancer

This Study Answers Longstanding Questions About Heated Chemotherapy for Ovarian Cancer!

Outcomes from conventional treatment of ovarian cancer not diagnosed very early remain unsatisfactory. Researchers have therefore long sought improvements, partly by developing new options and partly through more effective use of existing treatments.

HIPEC, heated chemotherapy delivered into the abdomen immediately after surgery in ovarian cancer with peritoneal spread, is a major example. Its timing, number of applications and side effects have long prompted debate. This study answered many questions and offered a practical recommendation.

HIPEC: Hyperthermic IntraPEritoneal Chemotherapy

Standard treatment for newly diagnosed advanced ovarian cancer combines cytoreductive surgery and systemic chemotherapy. A new study investigated adding HIPEC after prior tumor-shrinking (neoadjuvant) chemotherapy in stage 3 ovarian cancer to determine whether outcomes improved.

This multicenter, open-label stage 3 (phase-3) trial enrolled patients responding to three preoperative tumor-shrinking cycles of carboplatin-paclitaxel, assigning one arm to cytoreductive surgery plus heated chemotherapy (cisplatin ) and the other to surgery alone after neoadjuvant chemotherapy.

Adding heated chemotherapy was randomized among patients whose surgery left no visible disease (complete cytoreduction) or residual tumor no larger than 10 mm (optimal cytoreduction).

After surgery, preventive (adjuvant) treatment consisted of three further carboplatin-paclitaxel cycles. The primary objective was comparing time to recurrence (recurrence-free survival); secondary objectives were overall survival and side effects.

According to the Study Results:

• Adding heated chemotherapy reduced recurrence or death risk by 34%.
• Median recurrence-free survival was 11 months with surgery alone versus 14 months with HIPEC.
• At median follow-up of 4.7 years, 76 patients (62%) died after surgery alone, versus 61 (50%) after surgery-plus-HIPEC.
• Median overall survival was 34 months with surgery and 46 months with surgery-plus-HIPEC.
• Serious side effects (grade 3 or 4) were similar: 25% with surgery versus 27% with surgery-plus-HIPEC.

In conclusion , in stage 3 ovarian cancer, adding heated intraperitoneal chemotherapy to cytoreductive surgery improved recurrence-free and overall survival versus surgery alone without increasing side-effect risk.