Combined hyperthermic intraperitoneal chemotherapy and hyperthermic intrathoracic chemotherapy in stage IVA ovarian carcinoma: Single institution experience from North India

Introduction: Treatment of Stage IVA ovarian carcinoma needs a combined multidisciplinary team approach. The peritoneal disease needs adequate local treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Hyperthermic intrathoracic chemotherapy (HITHOC) is a reasonable treatment option for ovarian carcinoma with malignant pleural effusion or pleural deposits. The CRS with HIPEC and HITHOC needs collaborative surgical and anesthetic skills and is a more technically demanding procedure. Methods: We are sharing the experience of three advanced cases diagnosed with Stage IVA ovarian carcinoma with subdiaphragmatic deposits along with malignant pleural effusion, which were treated with CRS with combined HIPEC and HITHOC. The feasibility of combined HIPEC and HITHOC along with surgical sequelae and follow-up treatment outcomes are individually summarized. Results: All patients underwent the proposed surgery without any significant intraoperative complications. The postoperative morbidity was acceptable with no recorded mortality. One patient developed recurrent pleural disease on follow-up. Conclusions: HIPEC/HITHOC is an effective and safe therapeutic option to prevent recurrence in Stage IVA ovarian carcinoma, which has previously a dismal prognosis. In addition, the patient's general condition improved symptomatically and the respiratory distress level significantly reduced after the curative-intent treatment.