Abstract
Heated intraperitoneal chemotherapy (HIPEC) has several potential benefits. Higher doses of chemotherapy can be used with HIPEC because the plasma-peritoneal barrier results in little absorption into the blood stream. HIPEC offers higher peritoneal penetration in comparison to an intravenous (IV) regimen and does not have the traditional normothermic intraperitoneal (IP) regimen limitation of post-operative adhesions. Hyperthermia itself has cytotoxic effects and can potentiate antineoplastic effects of chemotherapy in part by increasing the depth of tumor penetration by up to 3 mm. For the treatment of ovarian cancer, HIPEC has been evaluated in the recurrent setting with secondary cytoreduction. Recent studies, including a prospective trial, have evaluated its role in primary management of ovarian cancer. This review summarizes previous and ongoing studies regarding the use of HIPEC in the management of ovarian cancer.
Highlights
Epithelial ovarian cancer (EOC) is the deadliest gynecologic malignancy [1]
Normothermic IP chemotherapy has been studied in prospective clinical trials in the post-operative treatment of primary EOC, and NCCN has noted the combined IV/IP regimen as preferred regimen for optimally cytoreduced Stage III EOC
Heated intraperitoneal chemotherapy (HIPEC) has more frequently been utilized in the recurrent setting with secondary cytoreduction surgery (CRS), but recent studies have evaluated its role in primary management of ovarian cancer
Summary
Epithelial ovarian cancer (EOC) is the deadliest gynecologic malignancy [1]. The majority of women are diagnosed at advanced stage with widely metastatic peritoneal disease. For most patients with EOC, the majority of disease burden is in the peritoneal cavity and can be quantified by the peritoneal cancer index (PCI) [3]. The PCI is a measure of the extent of disease burden in the peritoneal cavity. Due to this location, normothermic IP chemotherapy has been studied in prospective clinical trials in the post-operative treatment of primary EOC, and NCCN has noted the combined IV/IP regimen as preferred regimen for optimally cytoreduced Stage III EOC. HIPEC during CRS for EOC has been gaining more attention in the treatment of metastatic peritoneal disease. HIPEC has more frequently been utilized in the recurrent setting with secondary CRS, but recent studies have evaluated its role in primary management of ovarian cancer
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