Yigit Mehmet OZGUN, Murat ÖZ, Volkan ÖTER, Muhammet Kadri ÇOLAKOĞLU, Erol PİSKİN, Osman AYDİN, Erdal BOSTANCİ

Maksimal sitoredüksiyon sonrası Hipertermik İntraperitoneal Kemoterapi uygulamasının platin dirençli ve parsiyel duyarlı rekürren epitelyal over kanserinde sağ kalıma etkisi

Amaç: Over kanserlerinde nüks genellikle peritoneal metastaz ile olmaktadır. Bu durumda tedavi seçenekleri arasında sitoredüktüf cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK) önemli yer tutmaktadır. Özellikle platin dirençli ve parsiyel duyarlı rekürren epitelyal over kanserlerinde bu tedavi daha da önem kazanmaktadır. Çalışmamızda bu hasta grubuna uyguladığımız sitoredüktüf cerrahi ve hipertermik intraperitoneal kemoterapi tedavisin sonuçlarını analiz ettik. Gereç ve Yöntemler: 2014-2021 tarihleri arasında peritoneal nüks nedeni ile opere edilen platin dirençli ve parsiyel duyarlı patolojisi yüksek dereceli seröz over karsinom olan hastalar geriye dönük olarak incelendi. Çalışmaya sadece makroskopik rezidü tümör kalmayacak şekilde SRC ve HİPEK uygulanan hastalar dahil edildi. Hastaların erken ve uzun dönem sonuçları, takip sürecinde nüks gelişimi, hastalıksız ve toplam sağ kalım süreleri analiz edildi. Bulgular: Toplam 13 hasta çalışmaya dahil edildi. Hastaların, peritoneal karsinomatoz indeksi (PKİ), 3-25 arasında ve ortanca yaş 54 (32-77  11,5 SD) olarak saptandı. Bir hastaya hem sekonder hem tersiyer SRC ve HİPEK uygulandı. Ortanca hastane yatış süreleri ve takip süreleri sırası ile 14 gün ve 42 ay olarak bulundu. Beş hastada post operatif komplikasyon gözlendi. Tüm hastaların median hastalıksız sağ kalım (DFS) 41 ay, median sağ kalım (OS) 49 ay olarak bulundu. Sonuç: Platin dirençli ve parsiyel duyarlı rekürren epitelyal over kanserlerinde SRC ve HİPEK, kabul edilebilir morbidite oranları ile yapılabilmektedir. Makroskopik tümör bırakılmadan uygulanan sitoredüksiyon ile uzun sağ kalım sağlanabilmektedir. Sekonder ve tersiyer cerrahiler seçilmiş hastalarda faydalıdır.

Anahtar Kelimeler:

sitoredüksiyon, Hipertermik İntraperitoneal Kemoterapi, epitelyal over karsinomu, sağ kalım

Effect of Hyperthermic Intraperitoneal Chemotherapy application on survival in platinum-resistant and partially sensitive recurrent epithelial ovarian cancer after maximal cytoreduction

Aim: Recurrence in ovarian cancers is usually observed with peritoneal metastasis. In this cases, cytoreductive surgery (SRC) and hyperthermic intraperitoneal chemotherapy(HIPEC) have an important role among the treatment options. This treatment modality becomes more important especially in platinum-resistant and partially sensitive recurrent epithelial ovarian cancers. In our study, we analyzed the results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy treatment applied to this patient group. Materials and Method: We retrospectively analyzed the patients with high-grade serous ovarian carcinoma with platinum-resistant and partially sensitive pathology who were operated for peritoneal recurrence between 2014-2021. We only included the patients who underwent SRC and HIPEC without macroscopic residual tumor in the study. Early and long-term results of the patients, the development of relapse during the follow-up period, disease-free and overall survival times were analyzed. Results: A total of 13 patients were included in the study. The peritoneal carcinomatosis index (PCI) of the patients were between 3-25 and the median age was 54. One of our patient recieved both secondary and tertiary SRS and HIPEC. Median length of hospital stay and follow-up were 14 days and 42 months, respectively. Post operative complications were observed in five patients. The median disease-free survival (DFS) of all patients was 41 months, and the median overall survival (OS) was 49 months. Conclusion: In platinum-resistant and partially sensitive recurrent epithelial ovarian cancers, SRC and HIPEC can be performed with acceptable morbidity rates. Long survival can be achieved with complete cytoreduction. Secondary and tertiary surgeries are beneficial in selected patients.

Keywords:

cytoreductive surgery, hyperthermic intraperitoneal chemotherapy, epithelial ovarian carcinoma, survival,

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