Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as Primary Treatment of Ovarian Cancer: A Review of the Current Literature

Abstract

HIPEC has been proposed as an addition in the treatment of ovarian cancer. The purpose of this review was to evaluate the evidence and use of HIPEC after cytoreductive surgery as up-front therapy for inpatients with primary ovarian cancer. We performed a search on PubMed and Web of Science. Additional studies were identified by cross-referencing past reviews and published studies. Primary endpoints were overall survival and progression-free survival. Secondary endpoints were morbidity, mortality and completeness of cytoreduction score. We found 15 cohort studies eligible for review with data available for 2285 patients in total of which 924 had primary ovarian cancer and received CRS + HIPEC as up-front or interval debulking therapy. Seven studies reported a median OS higher than 50 months in 445 patients. Additionally, four studies reported a 5-year survival rate > 30% in 111 patients. The lowest survival rates were 35.4–43 months. CC-0 score of more than 90% was reported in four studies. PFS ranged from 11.8 to 30 months. Major morbidity directly related to HIPEC included leukopenia, thrombocytopenia and renal failure. Forty deaths were reported overall. CRS and HIPEC seems promising as treatment for primary ovarian cancer, however the vast number of patients reported treated with CRS + HIPEC are reported in retrospective studies without standard protocols therefor further randomized clinical trials are needed.