Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses the role of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced ovarian cancer.

HIPEC is one of the biggest topics in this space. Though many physicians offer HIPEC, there is little level 1 evidence to support its use, Leitao notes. Investigators in The Netherlands did a randomized trial in patients receiving neoadjuvant chemotherapy and interval debulking. Patients were randomized to receive HIPEC or not, followed by systemic therapy. Results showed a significant improvement in progression-free and overall survival, Leitao says.

That was the only randomized trial in this setting, so it’s something to take into consideration. However, if a surgeon has the proper training that would enable them to give HIPEC, they are justified in giving HIPEC to a patient undergoing interval debulking. The role of HIPEC in the setting of primary debulking and in the recurrent setting is still to be determined. A study at Memorial Sloan Kettering Cancer Center is nearing completion of accrual looking at HIPEC in patients with platinum-sensitive disease after first recurrence.

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Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses the role of HIPEC in patients with advanced ovarian cancer.

Dr. Leitao Discusses the Role of HIPEC in Advanced Ovarian Cancer

Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses patient eligibility for neoadjuvant chemotherapy in advanced ovarian cancer.

For patients with newly diagnosed advanced ovarian cancer, primary debulking surgery is still the recommended approach, says Leitao. However, for patients who are ineligible to undergo surgery, neoadjuvant chemotherapy may be an option. Neoadjuvant chemotherapy is typically considered in patients older than the age of 70, those with widespread metastatic disease, and those with a suboptimal performance status or low albumin level, says Leitao. Medical fitness can also help determine if a patient is able to undergo the extensive surgery.

If patients do not meet all 3 of these criteria, a CT scan is ordered to examine the patient’s disease distribution. This can help determine whether or not a complete cytoreduction is possible, and whether neoadjuvant chemotherapy should be given first, says Leitao.

Dr. Leitao on Eligibility for Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses the importance of surgery for patients with ovarian cancer.

It is important for patients to find a great surgeon because surgery is different than administering systemic therapies. A skilled surgeon offers the best benefit to patients with ovarian cancer, says Leitao.

There are potential fertility options for younger women with ovarian cancer, Leitao adds. Even in the recurrent setting, surgery can offer a benefit if done correctly and with the right surgeon.

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Dr. Leitao on the Benefits of Surgery in Ovarian Cancer

Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses the role of surgery for patients with ovarian cancer. 

Surgery continues to have a role in the treatment of patients with ovarian cancer, says Leitao. Now that surgeons can perform smaller incisions with less complications, more women are willing to consider surgery as an option. 

Surgery also plays a role in fertility preservation, explains Leitao. Select patients with early-stage ovarian cancer can receive surgery, chemotherapy, and potentially still give birth.  

Mario M. Leitao Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses the role of surgery for patients with ovarian cancer.

Dr. Leitao on the Role of Surgery in Ovarian Cancer

Mario M. Leitao, Jr, MD, FACOG, FACS, fellowship director, gynecology service, director, Minimal Access and Robotic Surgery Program, Department of Surgery, Memorial Sloan Kettering Cancer Center, discusses surgery in gynecologic malignancies.

Leitao says that lot of the focus regarding surgery in gynecologic malignancies is working to better identify the cancer during surgery in order to get better margins and reduce harm long term.

This may be done by better imaging techniques during operation, Leitao suggests, but that is a difficult approach.

Mario M. Leitao Jr, MD, FACOG, FACS

Articles

Dr. Leitao Discusses the Role of HIPEC in Advanced Ovarian Cancer

Dr. Leitao on Eligibility for Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

Dr. Leitao on the Benefits of Surgery in Ovarian Cancer

Dr. Leitao on the Role of Surgery in Ovarian Cancer

Dr. Leitao Discusses Surgery in Gynecologic Malignancies