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News

18Jan 2018

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Chance of survival from ovarian cancer greater with chemo lavage of the abdominal cavity (1)

Willemien van Driel

In women with metastases of ovarian cancer restricted to the abdominal cavity (stage III), it appears that hyperthermic intraperitoneal chemotherapy, HIPEC, improves the survival rate by 10%. Moreover, the treatment has almost no additional side effects. This research, led by the Netherlands Cancer Institute, was carried out in collaboration with five other hospitals and will be published in the prestigious New England Journal on January 18, 2018. A total of 245 patients participated in the study.

Ovarian cancer is the gynecological malignancy with the highest mortality worldwide. In the Netherlands, approximately 1300 women receive a diagnosis of ovarian cancer annually. In about 75% of cases, the disease has already metastasized in the abdomen when diagnosed. The standard treatment, in this case, consists of a comprehensive operation in combination with chemotherapy. There are two treatment strategies, the patient either starts with an operation followed by 6 courses of chemotherapy [primary debulking] or is given three chemotherapy courses before and three after the operation [interval debulking]. With this treatment, about a third of the patients are still alive after five years.

Over the last ten years, The Netherlands Cancer Institute has, in collaboration with five other hospitals (AMC, St. Antonius Hospital Nieuwegein/UMC Utrecht, UMC Groningen, Catharina Hospital Eindhoven and Radboud UMC), studied whether an abdominal lavage with heated chemotherapy in combination with interval debulking improves the chances of a cure. The study shows that, after five years, women who received a HIPEC treatment had 10% more chance of survival than women who did not undergo the HIPEC treatment. There was also no difference seen in the side effects or complications between the 2 groups, and the HIPEC was well tolerated.

Study design

Between 2007 and 2016, half of the number of women with stage III ovarian carcinoma who were treated with an interval debulking received the new HIPEC treatment. Prior to the operation, all of the women were given three rounds of chemotherapy. Women for whom the gynecologist was able to remove virtually all of the tumors during surgery were eligible for the study. A drawing of lots determined who got the abdominal lavage and who did not. The abdominal lavage was applied at the end of surgery. After surgery, all of the women were given three more rounds of chemotherapy.

What does this mean in practice?

The results of this study are now being published in the New England Journal of Medicine. The results of this study will be discussed by the guidelines committee for gynecological oncology. This treatment is expected to become part of the standard treatment in the Netherlands as soon as it is accepted as insured care and there is an agreement on the financial compensation for this treatment.

Reuters: Heated abdominal chemo bath improves ovarian cancer survival

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