Emel CANBAY, Tülay İREZ, Yutaka YONEMURA

Peritoneal metastazlı over karsinomu: Yaklaşımın yeniden düşünülmesi

Epitelyal tipte over karsinomu (EOK), genellikle ileri evrelerde teşhis edilen bir kanser türüdür. Bugüne kadar, EOC'nin standart tedavisi neoadjuvan veya adjuvan platin ve taksan bazlı sistemik kemoterapi ile kombine edilen cerrahi’dir. EOC'nin tekrarlaması durumunda hipertermik intraoperatif intraperitoneal kemoterapi (HİPEK) düşünülmektedir. HİPEK, over ve apendiks kaynaklı psödomiksoma peritonei tedavisinde altın standart olarak kabul edilmiştir. Son zamanlarda, randomize bir klinik çalışma, HIPEK'in, cerrahi serilerde yumurtalık kanserinin (OK) peritona metastazı (PM) için umut verici bir tedavi seçeneği olduğunu desteklemektedir. HİPEK'in ayrıca primer ve nüks OK'nin PM vakalarında etkili bir tedavi seçeneği olduğu bildirilmektedir. Sonuç olarak, HİPEK tekniğinin standardizasyonu ve optimizasyonu, tedavilere yanıt veren OK’nin PM'si olan hasta alt gruplarının belirlenmesi, kişiselleştirilmiş değerlendirme ve multidisipliner ekip tarafından hali hazırda yürütülen tedavilerin hala yeniden değerlendirilmesi gerekmektedir. Bu derlemede over kanserinin peritona metastazı durumunda standart tedavi yaklaşımı ile birlikte uygulamadaki sistemik tedaviler ve cerrahi ile kombine edilmiş HIPEK tedavi yaklaşımlarının güncellenmesi amaçlanmıştır.

Anahtar Kelimeler:

Periton Metastazı, over kanseri, sitoredüktif cerrahi, hipertermik intraperitoneal intraoperatif kemoterapi

Ovarian Carcinoma with Peritoneal Metastasis: Rethinking of Management

Epithelial Ovarian Carcinoma (EOC), a type of cancer that is usually diagnosed in advanced stages. To date, standard treatment of EOC is surgery with neoadjuvant or adjuvant platin and taxane based systemic chemotherapy. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) is considered in cases of recurrence of EOC. HIPEC has been accepted as a gold standart for the treatment of pseudomyoxoma peritonei of ovarian and appendiceal origin. More recently, a randomized clinical trial supports that HIPEC is a promising treatment option for peritoneal metastasis (PM) of ovarian cancer (OC) in surgical series. HIPEC is also reported to be an effective treatment option in primary and recurrent cancer cases with PM of OC. As a result, the standardization and optimization of the HIPEC technique, determination of patient subgroups with PM of the OC responding to treatments, personalized evaluation and the treatments currently carried out by the multidisciplinary team still need to be re-evaluated. In this review, it is aimed to update the standard treatment approach in case of peritoneal metastasis of ovarian cancer, along with the systemic treatments and HIPEC treatment approaches combined with surgery.

Keywords:

Peritoneal metastasis, ovarian cancer, cytoreductive surgery, hyperthermic intraperitoneal intraoperative chemotherapy,

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1. 1. van Niekerk CC, Vooijs P, Casparie-van Velsen IJ, Poels LG. Differentiation margins of ovarian tumor pathology: first incidences of epithelial ovarian tumors monitored by marker antibodies. Cancer Detect Prev. 1997;21:247-57.
2. Diagnosis:Types of Tumors.2019, http://ovariancancer.jhmi.edu/malignantepithelial.cfm.
3. Piek JM, van Diest PJ, Verheijen RH. Ovarian carcinogenesis: an alternative hypothesis. Adv Exp Med Biol. 2008;622:79-87.
4. ls R, Parmar M, Pecorelli S, Pfisterer J, Poveda A, Provencher D, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol. 2005;16 Suppl 8:viii7-viii12.
5. van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. N Engl J Med. 1995;332:629-34.
6. Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC, et al; Gynecologic Oncology Group. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med. 2004;351:2489-97.
7. Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, et al; Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34-43.
8. Alberts DS, Liu PY, Hannigan EV, O'Toole R, Williams SD, Young JA, et al. Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med. 1996;335:1950-5.
9. Markman M, Bundy BN, Alberts DS, Fowler JM, Clark-Pearson DL, Carson LF, et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol. 2001;19:1001-7.
10. Walker JL, Brady MF, Wenzel L, Fleming GF, Huang HQ, DiSilvestro PA, et al. Randomized Trial of Intravenous Versus Intraperitoneal Chemotherapy Plus Bevacizumab in Advanced Ovarian Carcinoma: An NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol. 2019;37:1380-90.
11. Tewari D, Java JJ, Salani R, Armstrong DK, Markman M, Herzog T, Monk BJ, Chan JK. Long-term survival advantage and prognostic factors associated with intraperitoneal chemotherapy treatment in advanced ovarian cancer: a gynecologic oncology group study. J Clin Oncol. 2015;33:1460-6.
12. Katsumata N, Yasuda M, Isonishi S, Takahashi F, Michimae H, Kimura E, et al; Japanese Gynecologic Oncology Group. Long-term results of dose-dense paclitaxel and carboplatin versus conventional paclitaxel and carboplatin for treatment of advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer (JGOG 3016): a randomised, controlled, open-label trial. Lancet Oncol. 2013;14:1020-6.
13. Chan JK, Brady MF, Penson RT, Huang H, Birrer MJ, Walker JL, et al.. Weekly vs. Every-3-Week Paclitaxel and Carboplatin for Ovarian Cancer. N Engl J Med. 2016;374:738-48.
14. Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DMet al. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial. Lancet. 2019;394:2084-95.
15. Pignata S, Scambia G, Katsaros D, Gallo C, Pujade-Lauraine E, De Placido S, et al. Carboplatin plus paclitaxel once a week versus every 3 weeks in patients with advanced ovarian cancer (MITO-7): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol. 2014;15:396-405.
16. Belotti D, Calcagno C, Garofalo A, Caronia D, Riccardi E, Giavazzi R, et al. Vascular endothelial growth factor stimulates organ-specific host matrix metalloproteinase-9 expression and ovarian cancer invasion. Mol Cancer Res. 2008;6:525-34.
17. Tewari KS, Burger RA, Enserro D, Norquist BM, Swisher EM, Brady MF, et al. Final Overall Survival of a Randomized Trial of Bevacizumab for Primary Treatment of Ovarian Cancer. J Clin Oncol. 2019;37:2317-28.
18. Perren TJ, Swart AM, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen Get al; ICON7 Investigators. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011;365:2484-96.
19. Vergote I, Hanker LC, Floquet A, Rau J, Kim JW, Ortega E, et al. AGO-OVAR 16: a phase III study to evaluate the efficacy and safety of pazopanib (PZ) monotherapy versus placebo in women who have not progressed after first line chemotherapy for epithelial ovarian, fallopian tube, or primary peritoneal cancer—overall survival (OS) results J. Clin. Oncol. 2018;36:5518-5518.
20. Vergote I, Scambia G, O'Malley DM, Van Calster B, Park SY, Del Campo JM, et al. Trebananib or placebo plus carboplatin and paclitaxel as first-line treatment for advanced ovarian cancer (TRINOVA-3/ENGOT-ov2/GOG-3001): a randomised, double-blind, phase 3 trial. Lancet Oncol. 2019;20:862-76.
21. du Bois A, Kristensen G, Ray-Coquard I, Reuss A, Pignata S, Colombo N, et al. Standard first-line chemotherapy with or without nintedanib for advanced ovarian cancer (AGO-OVAR 12): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol. 2016;17:78-89.
22. Mirza MR, Monk BJ, Herrstedt J, Oza AM, Mahner S, Redondo A, et al. Niraparib Maintenance Therapy in Platinum-Sensitive, Recurrent Ovarian Cancer. N Engl J Med. 2016;375:2154-64.
23. Vergote I, Amant F, Kristensen G, Ehlen T, Reed NS, Casado A. Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur J Cancer. 2011;47 Suppl 3:S88-92.
24. Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet. 2015;386:249-57.
25. Onda T, Satoh T, Ogawa G, Saito T, Kasamatsu T, Nakanishi T, et al; Japan Clinical Oncology Group. Comparison of survival between primary debulking surgery and neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomised trial. Eur J Cancer. 2020;130:114-25.
26. Fagotti A, Ferrandina MG, Vizzielli G, Pasciuto T, Fanfani F, Gallotta V, et al. Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850). Int J Gynecol Cancer. 2020;30:1657-64.
27. McQuellon RP, Loggie BW, Lehman AB, Russell GB, Fleming RA, Shen P, et al. Long-term survivorship and quality of life after cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Ann. Surg. Oncol. 2003;10:155–62.
28. Helm CW, Richard SD, Pan J, Bartlett D, Goodman MD, Hoefer R, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: first report of the HYPER-O registry. Int J Gynecol Cancer. 2010;20:61-9.
29. Huo YR, Richards A, Liauw W, Morris DL. Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2015;41:1578-89.
30. Lim MC, Chang SJ, Yoo HJ, Nam BH, Bristow R, Park SY, et al. Randomized trial of HIPEC in women with primary advanced peritoneal ovarian and tubal cancer J Clin Oncol. 2017;35:5520.
31. van Driel WJ, Koole SN, Sonke GS. Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med. 2018;378:1363-4.
32. Spiliotis J, Halkia E, Lianos E, Kalantzi N, Grivas A, Efstathiou E, et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol. 2015;22:1570-5.
33. Harter P, Reuss A, Sehouli J, Chiva L, du Bois A. Brief Report About the Role of Hyperthermic Intraperitoneal Chemotherapy in a Prospective Randomized Phase 3 Study in Recurrent Ovarian Cancer From Spiliotis et al. Int J Gynecol Cancer. 2017;27:246-7.