Improving methods of treatment of patients with recurrent ovarian cancer (OC) is an urgent and complex problem of modern oncogynecology, and requires the development of individual treatment tactics taking into account the characteristics of the metastatic process. Increasing of the effectiveness of combined treatment of patients with recurrent ovarian cancer through the differential use of cytoreductive surgery followed by hyperthermic or northermic intraperitoneal chemopertherapy is promising.
The study was conducted at the Department of Oncology and Radiology of the Danylo Halytsky Lviv National Medical University, on the basis of the Lviv State Oncological Regional Medical and Diagnostic Center (clinical base of the department) during 2015-2021. According to the design of the clinical study, 102 patients aged 38 to 76 years (mean age 55.09 ± 1.07 years) with recurrence of ovarian cancer and intraperitoneal spread of the tumor were examined and treated. Depending on the method of intraperitoneal chemotherapy, the examined patients were divided into 2 study groups. The first group (group I) consisted of 64 patients with recurrent OC who underwent hyperthermic intraperitoneal chemoperfusion. According to the degree of completeness of cytoreduction (CC), patients of group I were differentiated into subgroups - I A (32 patients who underwent CRS CC0 and IB (CC 1-3, n = 32). The second group (group II) included 38 patients who received normothermic intraperitoneal chemotherapy. The feasibility and effectiveness of normothermic intraperitoneal chemotherapy in patients with recurrent OC after cytoreduction have been studied for the first time.
In the preoperative phase, we investigated the role of radiation imaging to assess the degree of peritoneal carcinomatosis in patients with OC and in particular the diagnostic value of spiral computed tomography with contrast enhancement. To do this, we conducted a retrospective analysis of the medical records of 81 patients (mean age was 54.8 ± 2.1 years).
The obtained data were compared with the results of intraoperative determination of the peritoneal carcinomatosis index according to the classification of peritoneal carcinomatosis (7), which showed the presence of peritoneal lesions in the pelvis in 73 women (90.1%), central abdomen - in 72 patients (89.0%) ). Lesions of the peritoneum of the small intestine (except for the proximal part of the large intestine) were documented with the lowest frequency (49.3%).
It was found that in the examined women with recurrence of OC the peritoneal cancer index ranged from 3 to 36 points and its average value was 19.3 ± 1.2 points.
The size of peritoneal implants visualized by computed tomography (CT) in our cohort was correctly determined in 72.8% of cases, underestimated - in 24.7% and overestimated - in 2.5%. The overall sensitivity of CT was 62.0% (CI 56.1-67.9).
The dependence of CT sensitivity on the size of implant metastases was found: the number of true-positive results significantly (p <0.0001) increased with increasing diameter of metastases. The sensitivity of CT was the lowest (25.9%) with tumor sizes less than 1.0 cm, and the highest (87.9%) with sizes larger than 5 cm.
We evaluated the impact of cytoreduction complexity and the possibility of performing intraperitoneal chemopeofusion. In particular, patients of group I underwent from 2 to 13 stages of cytoreductive surgery (CRS) (average 5.3 ± 2.4 stages), women of group II - from 1 to 5 stages (average 1.6) ± 0.5 stages). Among women of subgroup IA in 100.0% of cases (n = 32) cytoreduction was performed in the volume of CC0, in patients of subgroup IB CRS CC1 was performed 13 subjects (40.6%), CC2 - 14 (43.8%), CC3 - 5 (15.6%). The largest proportion of patients in group II (78.9%, n = 30) received cytoreduction with a volume of CC2, and 4 patients (10.5%) - CC0 and CC1.
The results of ROC-analysis showed that with the number of cytoreduction stages above 3 in patients with OC recurrence, hyperthermic intraperitoneal chemotherapy (HIPEC) was predicted, and below - normothermic (sensitivity of the method - 100%, specificity - 87.2%).
It was found that the rate of surgical PCI in patients of group IA ranged from 3 to 17 and its average level was 9.3 and was statistically significant (p <0.05) lower than the level in group IB and in patients of group II.
With the help of ROC-analysis it was found that with the value of surgical PCI during CRS in patients with recurrence of OC below 24, HIPEC was predicted, and above - normothermic (sensitivity of the method - 88.9%, specificity - 63.8%) .
Analysis of long-term treatment outcomes of our cohort patients included assessment of OC progression-free survival and overall survival in patients after CRS and intraperitoneal chemotherapy.
It was found that among patients after HIPEC no progression of OC during 6 months of follow-up was found in 84.4%, while in
