Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC), along with optimal cytoreductive surgery, has been debated to be a viable option for the treatment of advanced epithelial ovarian cancer with peritoneal carcinomatosis. HIPEC is associated with a direct and improved penetration of chemotherapy drugs into the affected tissue and is associated with fewer systemic side effects. There is no standard protocol for the use of HIPEC in advanced ovarian cancer. Hence, there is controversy over the timing, dose, duration, and efficacy of HIPEC. In this review, the history, technique, current evidence, recommendations, and future directions of HIPEC are discussed.
Highlights
BackgroundOvarian malignancy is the most lethal of all gynecological cancers
Hyperthermic intraperitoneal chemotherapy, popularly called hyperthermic intraperitoneal chemotherapy (HIPEC), is a technique for delivering a chemotherapeutic agent, in which a heated solution of chemotherapy agent is perfused throughout the peritoneal space (Figure 1)
A case-control study conducted by Safra et al (2014) in women with recurrent epithelial ovarian cancer suggested significant improvement in five-year survival and progression-free survival in women undergoing surgery with HIPEC as compared to those receiving systemic chemotherapy alone
Summary
Ovarian malignancy is the most lethal of all gynecological cancers. The standard of care for ovarian cancer is surgery in early stages and platinum-based chemotherapy followed by interval debulking surgery in advanced cases. Hyperthermic intraperitoneal chemotherapy, popularly called hyperthermic intraperitoneal chemotherapy (HIPEC), is a technique for delivering a chemotherapeutic agent, in which a heated solution of chemotherapy agent is perfused throughout the peritoneal space (Figure 1) It has been used for the treatment of advanced peritoneal malignancies, including gastrointestinal (colorectal and appendiceal) and advanced ovarian cancers. Koga et al confirmed the role of combined hyperthermia and intraperitoneal chemotherapy in the treatment of implanted peritoneal cancer in rats [15]. Hyperthermia can be generated by various perfusion systems that are available These systems include closed circuit pumps, which deliver heated chemotherapy drugs through inflow catheters with drainage accomplished via outflow catheters. An ideal chemotherapy drug to be used for HIPEC should be cell-cycle non-specific, water-soluble, having a synergistic effect with heat, with a high molecular weight and proven cytotoxic effect.
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