Neoadjuvant Chemotherapy Following Hyperthermic Intraperitoneal Chemotherapy in Platinum-Sensitive Recurrent Ovarian Cancer: A Retrospective Cohort Study

Abstract

OBJECTIVE: This study aims to compare the efficacy of neoadjuvant chemotherapy (NACT) followed by secondary cytoreductive surgery (SCS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) versus SCS with HIPEC alone in patients with platinum-sensitive recurrent ovarian cancer. METHODS: A retrospective analysis was conducted on patients treated at Hospital Clínico Universitario Virgen de la Arrixaca from January 2011 to December 2024. Two cohorts were analyzed: those receiving NACT prior to SCS and HIPEC, and those undergoing SCS with HIPEC without prior NACT. The primary endpoint was progression-free survival (PFS), while secondary endpoints included overall survival (OS), peritoneal progression-free survival, extraperitoneal progression-free survival, and safety. RESULTS: A total of 86 patients were included in the study, with 39 in the NACT group and 47 in the non-NACT group. The non-NACT cohort exhibited a significantly longer PFS of 20 months compared to 12 months in the NACT group (p = 0.004). Median OS was also superior in the non-NACT group, at 88 months versus 34 months (p = 0.023). Patients in the NACT group experienced longer surgical durations, increased transfusion requirements, and a higher incidence of severe complications. CONCLUSIONS: The addition of NACT prior to SCS and HIPEC does not enhance survival outcomes for patients with platinum-sensitive recurrent ovarian cancer. In fact, those who underwent SCS with HIPEC alone demonstrated better PFS and OS, underscoring the importance of careful patient selection in optimizing treatment strategies.