ABSTRACT
BACKGROUND: The current treatment of ovarian cancer consists of cytoreductive surgery (CRS) and systemic chemotherapy. The aim of this study was to examine if hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative modality to treat this category of patients along with a second attempt of surgical resection and second- or third-line systemic chemotherapy afterward. METHODS: In an 8-year period (2006-2013), 120 women with advanced ovarian cancer (International Federation of Gynecology and Obstetrics [FIGO] IIIc and IV) who experienced disease recurrence after initial treatment with conservative or debulking surgery and systemic chemotherapy were randomized into two groups. Group A comprised 60 patients treated with CRS followed by HIPEC and then systemic chemotherapy. Group B comprised 60 patients treated with CRS only and systemic chemotherapy. RESULTS: The mean survival for group A was 26.7 versus 13.4 months in group B (p < 0.006). Three-year survival was 75 % for group A versus 18 % for group B (p < 0.01). In the HIPEC group, the mean survival was not different between patients with platinum-resistant disease versus platinum-sensitive disease (26.6 vs. 26.8 months). On the other hand, in the non-HIPEC group, there was a statistically significant difference between platinum-sensitive versus platinum-resistant disease (15.2 vs. 10.2 months, p < 0.002). Complete cytoreduction was associated with longer survival. Patients with a peritoneal cancer index score of <15 appeared also to have longer survival. CONCLUSIONS: The use of HIPEC along with the extent of the disease and the extent of cytoreduction play an important role in the survival of patients with recurrence in an initially advanced ovarian cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cytoreduction Surgical Procedures/mortality , Hyperthermia, Induced/mortality , Neoplasm Recurrence, Local/therapy , Neoplasms, Glandular and Epithelial/therapy , Ovarian Neoplasms/therapy , Peritoneal Neoplasms/therapy , Carcinoma, Ovarian Epithelial , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Injections, Intraperitoneal , Lymphatic Metastasis , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Neoplasms, Glandular and Epithelial/mortality , Neoplasms, Glandular and Epithelial/pathology , Ovarian Neoplasms/mortality , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/secondary , Prognosis , Prospective Studies , Survival RateABSTRACT
OBJECTIVE: The present study evaluates the management of 65 consecutive patients with post-pneumonic empyema thoracis (PET) treated in our department during the last ten years. MATERIALS: There were 51 male (78.5 %) and 14 female (21.5 %) aged 23 - 82 years. The initial cause of PET was pneumonia (postoperative and posttraumatic empyemas were excluded). In 2 cases, a bronchopleural fistula coexisted. Diagnosis was based on clinical, radiological and pleural fluid culture findings. Pneumonococci and staphylococci were the predominant bacterial isolates in our series. RESULTS: Tube thoracostomy drainage (TS) was performed in all our patients. Forty-nine patients (75.4 %) were successfully treated with TS alone. The other 16 patients were submitted to thoracotomy: lung decortication (n = 14) along with segmentectomy in two cases and the Eloesser procedure, also in two cases. The mortality rate reached 9.2 % (n = 6). Septic shock, multiple organ failure, cardiac insufficiency, and end-stage renal failure were the causes. CONCLUSIONS: 1. Complete drainage and full lung expansion by tube thoracostomy with suction are essential in the management of post-pneumonic empyema thoracis. Surgery should only be carried out right away if these conditions are not achieved. 2. Despite clinical experience and the major strategies and procedures available, the mortality remains high.
