Luigi Frigerio

We began a bi-centric prospective observational pilot study combining CRS and HIPEC (with cisplatin and paclitaxel) in upfront setting to NACT (with carboplatin and paclitaxel) only in patients who had shown response to NACT itself. Between December 2009 and October 2011, 8 patients with advanced EOC (6 stage IIIC, 2 stage  IV)  were  treated  with  CRS  and  cisplatin+paclitaxel-based HIPEC.  Mean  age  was  54.6 years  (median  54.5,  range  45–65).  6 patients  underwent  CRS  and  HIPEC  after  four  courses  of  taxol- carboplatin based NACT, one after three and one after six, in order to achieve optimal clinical response (>50%, according to the RECIST 1.1 criteria). Clinical response to NACT was complete in 3 patients and partial in 5 patients. At operation, mean PCI was 14 (median 13, range 5–28). All patients underwent CRS resulting in CC0 disease prior  to  HIPEC.  Supramesocolic  compartment  peritonectomy  was required  in  4  patients.  5  patients  underwent  colorectal  resection and anastomosis, with temporary diverting ileostomy. All patients underwent  HIPEC  with  cisplatin  100 mg/m 2 of  body  surface  area and paclitaxel 175 mg/m 2 of body surface area at 42 °C, with an intra- peritoneal infusion time of 90 min. Mean operative time was 522 min (median 540, range 400–595). Mean ICU stay was 2 days (median 2, range 1–5). Mean postoperative stay was 22 days (median 22, range 9–35). No postoperative mortality was observed. One patient experienced a grade 3 postoperative complication (pelvic abscess), requiring reopera- tive debridement and drainage. One patient refused adjuvant systemic chemotherapy.  The  remaining  7  patients  started  adjuvant  systemic chemotherapy. Median time to chemotherapy was 36 days (median 29, range 25–62).All patients are alive, with a mean follow up of 9 months (median 8, range 2–24). 7 patients are disease-free at follow up. One patient showed a raising Ca 125 after 10 months of follow up.