title: Hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer.
abstract: Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too often diagnosed at an advanced stage with peritoneal carcinomatosis (PC), but remains confined to the peritoneal cavity throughout much of its natural history. Because of cellular selection pressure over time, most tumor recurrences eventually develop resistance to systemic platinum. Options for salvage therapy include alternative systemic chemotherapies and further cytoreductive surgery (CRS), but the prognosis remains poor. Over the past two decades, a new therapeutic approach to PC has been developed that combines CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has already been shown to be effective in non-gynecologic carcinomatosis in numerous reports. There is a strong rationale for the use of HIPEC for PC of ovarian origin. On the one hand, three prospective randomized trials have demonstrated the superiority of intraperitoneal chemotherapy (without hyperthermia) in selected patients compared to systemic chemotherapy. Moreover, retrospective studies and case-control studies of HIPEC have reported encouraging survival data, especially when used to treat chemoresistant recurrence. However, HIPEC has specific morbidity and mortality; this calls for very careful selection of eligible patients by a multidisciplinary team in specialized centers. HIPEC needs to be evaluated by means of randomized trials for ovarian cancer at different developmental stages: as first line therapy, as consolidation, and for chemoresistant recurrence. Several European phase III studies are currently ongoing.
authors.affiliation: Service de gynécologie, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France; EMR 3738, université Lyon-1, 69000 Lyon, France.
authors.forename: N
authors.initials: N
authors.lastname: Bakrin
authors.affiliation: Centre René-Gauducheau, 44000 Nantes, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Classe
authors.affiliation: Centre Jean-Perrin, 63000 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Pomel
authors.affiliation: Institut Gustave-Roussy, 94085 Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Service de gynécologie, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Chene
authors.affiliation: EMR 3738, université Lyon-1, 69000 Lyon, France; Service de chirurgie générale et oncologique, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France. Electronic address: olivier.glehen@chu-lyon.fr.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002277:Carcinoma / Q000556:secondary / Q000628:therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000628:therapy; D006801:Humans; D006979:Hyperthermia, Induced; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000628:therapy*
keywords: Hyperthermia; Hyperthermic intraperitoneal chemotherapy (HIPEC); Ovarian cancer; Peritoneal carcinomatosis