Luigi Frigerio

Background and aims: Neoadjuvant chemotherapy (NACT) in patients with epithelial ovarian cancer (EOC) followed by interval cytoriductive surgery (CRS) is not inferior to primary CRS followed by chemotherapy as a treatment in advanced disesase (1). We adopted NACT before CRS in association to hyperthermic intraoperative peritoneal chemotherapy (HIPEC) (2). This clinical approach could have various advantages specially using NACT to select chemosensitive patients and thus offering HIPEC to those highly responders.

Methods: We began a prospective observational pilot study in 8 patients with advanced EOC combining CRS and HIPEC in upfront setting to NACT in chemo-responder patients.

Results: 8 patients with EOC were enrolled in the pilot study. Clinical response to NACT (cisplatin and paclitaxel) was complete in 3 patients and partial in 5 cases. All patients underwent CRS resulting in Complete Cytoreduction (CC0) disease. Supramesocolic peritonectomy was required in 4 patients and 5 patients underwent colorectal resection. All patients underwent HIPEC with cisplatin 100 mg/m2 and paclitaxel 175 mg/m2 of body surface area at 42 °C. No postoperative mortality was observed. One patient experienced a grade 3 postoperative complication. All patients are alive, with a mean follow up of 9 months. Seven patients are disease-free at follow up. One patient showed a raising Ca 125 after 10 months of follow up.

Conclusions: This encouraging pilot study confirms the existing data in the literature and has led us to start enrollment of patients in a multicenter phase 3 prospective RCT (CHORINE), comparing CRS + HIPEC vs. CRS alone in Stage IIIC unresectable EOC with partial or complete response after 3 systemic cycles of NACT.