Pattern of Care in Real-World Scenario on Advanced Epithelial Ovarian Cancer in a Tertiary Referral Oncology Centre in India — ISPSM Collaborative Study
Tóm tắt
The treatment of advanced epithelial ovarian cancer (EOC) has evolved over time. With advent of platinum-based chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC), there is a paradigm shift in the patterns of care with improved survival. In this study, we analysed our advanced EOC patients aiming to gain insights into the pattern of care. An ambispective study of 250 patients of advanced EOC was done from our prospectively maintained computerised database in the Department of Surgical Oncology, tertiary care referral centre from 2013 to 2020. We analysed the demographic profile, treatment patterns, and perioperative outcomes. In this study, there were 83.6% stage III and 16.4% stage IVA. There were 62 (24.8%) upfront and 112 (44.8%) in interval settings. There was a higher number of patients receiving neo-adjuvant chemotherapy. One hundred twenty-six (50.4%) underwent cytoreductive surgery (CRS) only and 124 (49.6%) underwent CRS and HIPEC. CC-0 was achieved in 84.4% and CC-1 in 15.6% patients. HIPEC programme was started in 2013. With advent of RCTs in HIPEC, there was a substantial increase in the number of patients receiving HIPEC from 2015 (n = 10), 2017 (n = 20) to 2019 (n = 41). We offer secondary CRS in a limited subset of patients, n = 76 (30.4%). There was 24.8% early and 8.4% late postop complications. We have median follow-up of 50 months with attrition rate of 4%. With practice changing updates, the treatment of advanced EOC has been evolving over time. Though the primary CRS followed by systemic therapy is the standard to date, there is change in pattern of care with neo-adjuvant chemotherapy followed by interval CRS and HIPEC because of various RCTs. The addition of HIPEC has acceptable morbidity and mortality. There is a definite learning curve and the team has to evolve as a whole. In a tertiary care referral centre from LMIC, good patient selection, logistics, and implementing recent advances will definitely add to improved survival.
Tài liệu tham khảo
National Cancer Institute; Surveillance, Epidemiology, and End Results [SEER] program. Globocan fact sheets: ovary cancer. 2018
Bercow AS, Chen A, Chatterjee S (2017) Cost of care for the initial management of ovarian cancer. Obstet Gynecol 130(6):1269–1275
Gilks CB, Prat J (2009) Ovarian carcinoma pathology and genetics: recent advances. Hum Pathol 40:1213–1223
McCluggage WG (2008) My approach to and thoughts on the typing of ovarian carcinomas. J Clin Pathol 61:152–163
McCluggage WG (2011) Morphological subtypes of ovarian carcinoma: a review with emphasis on new developments and pathogenesis. Pathology 43:420–432
Jesus E (2009) Technology of hyperthermic intraperitoneal chemotherapy in the United States, Europe, China. Japan and Korea Cancer J 15(3):249–254
DeVita VT Jr, Lawrence TS, Rosenberg SA (2010) Cancer: principles and practice of oncology-Annual Advances in Oncology. Lippincott Williams and Wilkins 1:188–193
Casado-Adam A, Alderman R, Stuart OA, Chang D, Sugarbaker PH (2011) Gastrointestinal complications in 147 consecutive patients with peritoneal surface malignancy treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy. Int J Surg Oncol 2011:468698
Glehen O, Osinsky D, Cotte E, Kwiatkowski F, Freyer G, Isaac S et al (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10(8):863–869
Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C et al (2006) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal Ray MD et al. Int J Reprod Contracept Obstet Gynecol. 2022 Oct;11(10):2723–2728 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 11 · Issue 10 Page 2728 surface malignancies treated with closed abdomen technique. Cancer 106(5):1144–53
Hansson J, Graf W, Pahlman L, Nygren P, Mahteme H (2009) Postoperative adverse events and long-term survival after cytoreductive surgery and intraperitoneal chemotherapy. Eur J Surg Oncol 35(2):202–208
Youssef H, Newman C, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ (2011) Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin. Dis Colon Rectum 54(3):293–299
Preti V, Chang D, Sugarbaker PH (2012) Pulmonary complications following cytoreductive surgery and perioperative chemotherapy in 147 consecutive patients. Gastroenterol Res Pract 2012:635314
Sugarbaker P, Van der Speeten K, Stuart O, Chang D, Mahteme H. Patient-and treatment-related variables, adverse events and their statistical relationship for treatment of peritoneal metastases. In: Sugarbaker PH, editor. Cytoreductive surgery and perioperative chemotherapy for peritoneal surface malignancy: textbook and video atlas. Connecticut: Cine-Med. 2012
Yan TD, Zappa L, Edwards G, Alderman R, Marquardt CE, Sugarbaker PH (2007) Perioperative outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy for non-appendiceal peritoneal carcinomatosis from a prospective database. J SurgOncol 96(2):102–112
Chereau E, Ballester M, Selle F, Cortez A, Pomel C, Darai E et al (2009) Pulmonary morbidity of diaphragmatic surgery for stage III/IV ovarian cancer. BJOG 116(8):1062–1068
Dowdy SC, Loewen RT, Aletti G, Feitoza SS, Cliby W (2008) Assessment of outcomes and morbidity following diaphragmatic peritonectomy for women with ovarian carcinoma. Gynecol Oncol 109(2):303–307
Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg 94(11):1408–1414
Mohamed F, Moran BJ (2009) Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer J 15(3):196–199
Ahmad SA, Kim J, Sussman JJ, Soldano DA, Pennington LJ, James LE et al (2004) Reduced morbidity following cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion. Ann Surg Oncol 11(4):387–392
Muller H, Hahn M, Weller L, Simsa J (2008) Strategies to reduce perioperative morbidity in cytoreductive surgery. Hepato-Gastroenterol 55(86–87):1523–1529
Hakeam HA, Breakiet M, Azzam A, Nadeem A, Amin T (2014) The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery. Ren Fail 36(10):1486–1491
Bakrin N, Bereder JM, Decullier E, Classe JM, Msika S, Lorimier G et al (2013) Peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced ovarian carcinoma: a French multicentre retrospective cohort study of 566 patients. Eur J Surg Oncol 39(12):1435–1443
Verwaal V, Bruin S, Boot H, van Slooten G, van Tinteren H (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15(9):2426–2432
Vukadinovic V, Chiou JD, Morris DL (2015) Clinical features of pulmonary emboli in patients following cytoreductive surgery (peritonectomy) and hyperthermic intraperitoneal chemotherapy (HIPEC), a single center experience. Eur J Surg Oncol 41(5):702–706
Chicago Consensus Working Group (2020) The Chicago Consensus Guidelines for peritoneal surface malignancies: introduction. Cancer 126(11):2510–2512
Van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, Schreuder HWR, Hermans RHM et al (2018) Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 378(3):230–40
Spiliotis J, Halkia E, Lianos E, Kalantzi N, Grivas A, Efstathiou E et al (2015) Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol 22(5):1570–1575
Kim SI, Cho J, Lee EJ (2019) Selection of patients with ovarian cancer who may show survival benefit from hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis. Medicine (Baltimore) 98(50):e18355