While ovarian cancer remains the deadliest of all cancers of the reproductive system, the medical community has made some important strides in treating it. In fact, the American Cancer Society has reported a 29 percent decline in ovarian cancer rates from 1985 to 2014, finding that deaths from the disease dropped 33 percent from 1976 to 2015. And while that’s reason for hope in our ongoing fight against this disease, it probably means a lot less to the more than 22,500 women who are diagnosed with ovarian cancer each year, and their loved ones.
But treatment advances are making an important difference. Surgery is the cornerstone of treatment for ovarian cancer, with a goal of removing as much of the tumor as possible—a process called debulking. The procedure is usually either preceded or followed by systemic chemotherapy, in which chemotherapy is infused into the bloodstream.
Reason for hope
Recent research offers more reason for optimism. One 2018 study, conducted in the Netherlands and published in the New England Journal of Medicine, found that some ovarian cancer patients experienced improved quality of life and a 12-month improvement in their median overall survival rate when their interval debulking surgery involved a process called hyperthermic intraperitoneal chemotherapy (HIPEC).
In March, the National Comprehensive Cancer Network, a nonprofit alliance of 28 U.S. cancer centers, released updated guidelines stating that HIPEC using the chemotherapy drug cisplatin can be considered with debulking surgery for stage 3 epithelial ovarian cancer patients. The guidelines, and the research supporting them, show that HIPEC has gained recognition as a promising procedure for an advanced and complex disease.
The procedure itself is highly sophisticated. Immediately after the tumor or cancerous lesions are removed, and during the same surgery, a highly concentrated, heated dose of chemotherapy is delivered directly to the abdomen, targeting the area where the treatment is needed most. This local delivery and subsequent removal of the drug reduce chemotherapy exposure to the rest of the body.
This combination of surgery and chemotherapy achieves a few important goals. First, the patient receives higher doses of chemotherapy. Second, heating the solution may improve its ability to destroy cancer cells. Third, HIPEC may help destroy microscopic cancer cells that remain in the abdomen after surgery.
Because the chemotherapy is delivered directly to the abdomen, patients may also experience reduced side effects, and the rest of the body may be exposed to less chemotherapy than through systemic chemotherapy.
“At CTCA, we have seen certain patients who fit the criteria for this treatment respond well,” says Hatem Halabi, MD, FACS, Director of Surgical Oncology at the Gastrointestinal Cancer Institute at Cancer Treatment Centers of America® (CTCA). “This is a promising development as we continue to look for options to help support patients’ length and quality of life.”
Chemotherapy and beyond
As with any cancer, the type of chemotherapy, the specific combination of medicine, and the methods used to administer the drugs depend on many factors, including the type and stage of ovarian cancer, the patient’s overall health and potential treatment-related side effects.
Because HIPEC is an invasive treatment, with sometimes-significant side effects, it is not recommended for every patient. Those who do undergo the procedure should work closely with an integrative care team trained in supportive care services, to help manage side effects and improve quality of life, before and after treatment.
“As patients talk with their doctor to determine the best course of treatment, it’s important to consider available options that may give advanced ovarian cancer patients better chances for survival,” says Julian Schink, MD, Chief Medical Officer and Chief of the Division of Gynecologic Oncology at CTCA®. “Our team has considerable expertise in managing the side effects of intensive chemotherapy, such as those produced by HIPEC.”
