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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review

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Abstract

Cytoreductive surgery (CRS) is an appropriate treatment for selected patients with endometrial cancer (EC)-derived peritoneal metastases (PM). Hyperthermic intraperitoneal chemotherapy (HIPEC) may enhance the therapeutic efficacy of CRS in these patients. We performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials and case reports reporting on the safety and efficacy of CRS and HIPEC in patients with EC-derived PM. Eight publications reporting on 68 patients were identified. The mean patient age was 57.1 years and the mean time from initial treatment of EC to CRS and HIPEC was 22.3 months. 41/64 patients had adenocarcinomas, type II cancers were present in 23/64 patients. The mean peritoneal carcinomatosis index (PCI) was 16.7. A complete surgical resection CC-0 was achieved in 44/63 (70%) patients. The chemotherapy regimens used for HIPEC were variable, but all included cisplatin, administered either alone (39/68 patients) or combined with doxorubicin or paclitaxel or mitomycin (29/68 patients). The duration of HIPEC was 60 min in 51/68 patients and 90 min in 17/68 patients. Mostly, the closed technique was used (55/68 patients). Adverse events grades 1/2, 3, and 4 were observed in 23/63, 12/63, and 6/63 patients, respectively. Treatment-associated mortality was 1% (1/63). After CRS and HIPEC, most patients received systemic chemotherapy (46/63 patients). Median disease-free and overall survival ranged from 7 to 18 and 12 to 33 months, respectively. In conclusion, CRS and HIPEC in EC with PM is safe and feasible. An additional therapeutic value of HIPEC is suggested, but prospective comparative trials are warranted.

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Abbreviations

Adeno-CA:

Adenocarcinoma

CC:

Complete cytoreduction

CD:

Clavien-Dindo classification

CIS:

Cisplatin

COS:

Cohort study

CR:

Case report

CRS:

Cytoreductive surgery

CS:

Case series

CTCAE:

Common toxicity criteria for adverse events

DFS:

Disease-free survival

DOXO:

Doxorubicin

EC:

Endometrial cancer

HIPEC:

Hyperthermic intraperitoneal chemotherapy

ICU:

Intensive care unit

MITO:

Mitomycin

OS:

Overall survival

PAC:

Paclitaxel

PM:

Peritoneal metastases

PCI:

Peritoneal carcinomatosis index

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Ruhr-Universität Bochum, Bochum, Germany

    Clemens B. Tempfer, Askin Dogan, Ziad Hilal & Günther A. Rezniczek

  2. Comprehensive Cancer Center of the Ruhr-Universität Bochum (RUCCC), Bochum, Germany

    Clemens B. Tempfer

  3. Department of Gynecology and Obstetrics, St. Elisabeth-Krankenhaus, Ruhr-Universität Bochum, Bochum, Germany

    Peter Kern

  4. Marien Hospital Herne, Hölkeskampring 40, 44625, Herne, Germany

    Clemens B. Tempfer

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  1. Clemens B. Tempfer
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  2. Peter Kern
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  3. Askin Dogan
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Contributions

CBT and AD collected data and wrote the manuscript. GAR analyzed the data. ZH and PK provided critical contributions to the manuscript. All authors participated in discussion and revision of the manuscript.

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Correspondence to Clemens B. Tempfer.

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Tempfer, C.B., Kern, P., Dogan, A. et al. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for endometrial cancer-derived peritoneal metastases: a systematic review. Clin Exp Metastasis 36, 321–329 (2019). https://doi.org/10.1007/s10585-019-09970-5

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  • DOI: https://doi.org/10.1007/s10585-019-09970-5

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