An overview and update of hyperthermic intraperitoneal chemotherapy in ovarian cancer

ABSTRACT

Introduction:

Despite, the strong rationale and evidence of the benefit of postoperative intraperitoneal chemotherapy in advanced ovarian cancer, it has not been widely adopted, mainly due to its high morbidity and logistical difficulties. Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is a more tolerable and technically feasible method of intraperitoneal chemotherapy, whereas other potential advantages include homogenous drug distribution, application before tumor regrowth and combination with hyperthermia, which is directly cytotoxic and enhances the efficacy of many drugs.

Areas covered:

In this review, the authors explain the rationale and indications for cytoreductive surgery (CRS) and HIPEC in advanced ovarian cancer. Data of major clinical studies, meta-analyses, and recent randomized trials are discussed.

Expert opinion:

After many encouraging clinical studies and meta-analyses, a recent randomized study demonstrated survival benefit for HIPEC during interval CRS in primary ovarian cancer, without increased morbidity, whereas another implied its benefit in recurrent ovarian cancer. Results of recently completed and numerous ongoing randomized studies will further determine the benefit of HIPEC in ovarian cancer at different time points. Patient selection and appraisal of the best protocols are crucial. The field of gynecological oncology will most likely evolve to include HIPEC eventually as a routine treatment for ovarian cancer.

KEYWORDS:

• Ovarian cancer
• intraperitoneal chemotherapy
• hyperthermia
• hyperthermic intraperitoneal chemotherapy
• HIPEC

Article highlights

• There is a strong rationale and evidence of the benefit of postoperative intraperitoneal chemotherapy in advanced ovarian cancer, but it has not been widely adopted, mainly due to its high morbidity and logistical difficulties.

• Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is a more tolerable and technically feasible method of intraperitoneal chemotherapy and has other potential advantages including more homogenous drug distribution, application before tumor regrowth, and combination with hyperthermia.

• Optimal cytoreductive surgery (CRS) and adequate patient selection are essential for effective treatment with HIPEC, which is not associated with significantly increased morbidity.

• After many encouraging clinical studies and meta-analyses, a recent randomized study demonstrated survival benefit for HIPEC during interval CRS in primary ovarian cancer, without increased morbidity, whereas another randomized study implied its benefit in recurrent ovarian cancer.

• Recent NCCN guidelines include the option to consider HIPEC at the time of interval CRS.

Results of recently completed and numerous ongoing randomized studies will further determine the benefit of HIPEC in advanced ovarian cancer at different time points.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The manuscript was not funded.