title: Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Emerging evidence suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) shows a survival benefit over CRS alone for patients with epithelial ovarian carcinoma (EOC). This systematic review and meta-analysis will assess the safety and efficacy of HIPEC with CRS for EOC.
  
  
  METHODS
  Searches of five databases from inception to 17/02/15 was performed. Clinical outcomes were synthesised, with full tabulation of results.
  
  
  RESULTS
  A total of 9 comparative studies and 28 studies examining HIPEC + CRS for primary and/or recurrent EOC were included. Meta-analysis of the comparative studies showed HIPEC + CRS + chemotherapy had significantly better 1-year survival compared with CRS + chemotherapy alone (OR: 3.76, 95% CI 1.81-7.82). The benefit of HIPEC + CRS continued for 2-, 3-, 4-, 5- and 8-year survival compared to CRS alone (OR: 2.76, 95% CI 1.71-4.26; OR: 5.04, 95% CI 3.24-7.85; OR: 3.51, 95% CI 2.00-6.17; OR: 3.46 95% CI 2.19-5.48; OR: 2.42, 95% 1.38-4.24, respectively). Morbidity and mortality rates were similar. Pooled analysis of all studies showed that among patients with primary EOC, the median, 1-, 3-, and 5-year overall survival rates are 46.1 months, 88.2%, 62.7% and 51%. For recurrent EOC, the median, 1-, 3-, and 5-year overall survival rates are 34.9 months, 88.6%, 64.8% and 46.3%. A step-wise positive correlation between completeness of cytoreduction and survival was found.
  
  
  CONCLUSIONS
  The addition of HIPEC to CRS and chemotherapy improves overall survival rates for both primary and recurrent EOC.
authors.affiliation: Department of Surgery, St George Hospital, University of New South Wales, Kogarah, Sydney, NSW 2217, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Y R
authors.initials: YR
authors.lastname: Huo
authors.affiliation: St George Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Richards
authors.affiliation: Cancer Care Centre, St George Hospital, Kogarah, Sydney, NSW 2217, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Liauw
authors.affiliation: Department of Surgery, St George Hospital, University of New South Wales, Kogarah, Sydney, NSW 2217, Australia; St George Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: david.morris@unsw.edu.au.
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D010051:Ovarian Neoplasms / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: CRS; Cytoreductive surgery; HIPEC; Hyperthermic intraperitoneal chemotherapy; Meta-analysis; Ovarian cancer; Review