Paul H Sugarbaker
Washington Cancer Institute, Washington, USA
Title: Optimizing the management of advanced ovarian malignancy using cytoreductive surgery plus regional and systemic chemotherapy
Biography
Biography: Paul H Sugarbaker
Abstract
Background: Ovarian cancer presents in a majority of patients with cancer dissemination widely distributed on the peritoneal
surfaces of the abdomen and pelvis. In a substantial proportion of patient’s not only peritoneal metastases but also lymph nodal
metastases will be present at the time of diagnosis.
Methods: Th e procedures required for complete surgical removal of all clinical evidence of ovarian cancer is pursued using
complete cytoreductive surgery (CRS). Th is may be performed either before or aft er neoadjuvant systemic chemotherapy.
At the time of surgery hyperthermic intraperitoneal chemotherapy (HIPEC) is used to improve the control of peritoneal
metastases. As the patient recovers from CRS plus HIPEC, combined intraperitoneal and systemic chemotherapy are initiated
for a six month interval.
Results: Cytoreductive surgery is associated with marked improvement in survival especially when all visible evidence of
disease is removed. In addition, HIPEC has been shown in randomized controlled trials to improve survival, primarily by
limiting the recurrence of peritoneal metastases. Also, long-term normothermic intraperitoneal chemotherapy (NIPEC-LT)
combined with systemic chemotherapy has been shown in randomized trials to show signifi cant benefi ts.
Conclusions: Combinations of complete CRS, HIPEC combined in the operating room with CRS and then NIPEC-LT plus
systemic chemotherapy will optimize the long-term survival of patients with advanced ovarian malignancy. Th e clinical
evidence for these benefi ts can be organized into an evidence-based treatment plan for this disease.