title: Survival benefit of adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the different time-points of treatment of ovarian cancer: review of evidence.
abstract: The standard treatment for advanced ovarian cancer consists in complete cytoreductive surgery (CRS) and intravenous combination chemotherapy with a platinum compound and a taxane. Although response rates to initial therapy are high, many patients will recur and die of peritoneal carcinomatosis. The addition of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) to the standard therapy aims at increasing survival by reducing peritoneal recurrence. This review describes the survival results of HIPEC at the different time-points of the treatment of ovarian cancer: at upfront CRS, at interval CRS, at consolidation CRS after complete response to initial therapy, at secondary CRS after incomplete response, at salvage CRS for recurrence and as palliative treatment without CRS for unresectable ovarian cancer with chemotherapy resistant ascites. The available evidence suggests that a potential survival benefit of adding HIPEC may be largest in the settings of secondary CRS for stage III ovarian cancer and salvage CRS for recurrent ovarian cancer, two time-points representing failure of initial standard therapy. There is much less evidence for a potential benefit of HIPEC for less advanced stages (I-II) and for earlier time-points in the treatment of ovarian cancer (upfront, interval and consolidation). Postoperative mortality is not higher after CRS and HIPEC (0.7%) than after CRS only (1.4%). Four randomised trials are ongoing and their results are eagerly awaited. Palliative HIPEC without CRS might be used more in patients with incapacitating ascites due to recurrent ovarian cancer which has become resistant to systemic chemotherapy.
authors.affiliation: Department of Surgery, Leopold Park Clinic, CHIREC Cancer Institute, Froissartstraat 38, 1040 Brussels, Belgium. stefaan.mulier@skynet.be
authors.forename: Stefaan
authors.initials: S
authors.lastname: Mulier
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Claes
authors.forename: Vincent
authors.initials: V
authors.lastname: Dierieck
authors.forename: Jean-Olivier
authors.initials: JO
authors.lastname: Amiel
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Pahaut
authors.forename: Luc
authors.initials: L
authors.lastname: Marcelis
authors.forename: Fabienne
authors.initials: F
authors.lastname: Bastin
authors.forename: Denis
authors.initials: D
authors.lastname: Vanderbeeken
authors.forename: Claude
authors.initials: C
authors.lastname: Finet
authors.forename: Sophie
authors.initials: S
authors.lastname: Cran
authors.forename: Thierry
authors.initials: T
authors.lastname: Velu
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000628:therapy*; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents