Abstract
Simple SummarySince 2000, scientific literature has recommended the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of ovarian cancer relapse. This treatment, combining heavy abdominal surgery and intraperitoneal heated chemotherapy is associated with a risk of post-operative death and severe morbidity. Previous systematic reviews of the scientific literature concluded that HIPEC was effective for improving patient survival following a first relapse of ovarian cancer. This current systematic review, emphasizing the level of evidence of the published series, using the Oxford levels of evidence grading system, has made it possible to analyze the weaknesses of this scientific literature. This literature is characterized by biases—such as patient inclusion, and weak methods—such as retrospective patient collection, a small number of included patients, and no statistical hypothesis. As a results, HIPEC must remain an experimental procedure in ovarian cancer relapse, patients until there are positive results from ongoing clinical trials.Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) is routinely used in the treatment of a first ovarian cancer relapse. Methods: This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, aimed to assess the quality of scientific proof of the survival benefits of HIPEC, using Medline and Google Scholar. Qualitative analysis using the Oxford CEBM Levels of Evidence 2011 grading is reported. Results: Of 469 articles identified, 23 were included; 15 based on series of patients treated with HIPEC without a control group, and 8 case control series of patients treated with or without HIPEC. The series without a control group showed median overall survival (OS) ranged from 23.5 to 63 months, highlighting a broad standard deviation. Considering the case control series, OS was significantly better in the HIPEC group in 5 studies, and similar in 1. The current review showed considerable heterogeneity and biases, with an Oxford Level of Evidence grading of 4 for 22 selected series and 2 for one. Conclusions: There is no strong evidence to suggest efficacy of HIPEC in improving survival of patients treated for a first relapse of ovarian cancer due to the low quality of the data.
Highlights
Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) has been used for ovarian cancer relapse since 2000, it is still not part of standard treatment [1].Historically, first line standard treatment with complete resection surgery and intravenous bi chemotherapy, +/− bevacizumab, fails to prevent the spread of this peritoneal tumor
The maximal tolerated dose (MTD) of cisplatin used in Hyperthermic intraperitoneal chemotherapy (HIPEC) ranged from 70 mg/m2 to 100 mg/m2 based on prospective phase I
We showed a statistically significant correlation between progression-free survival (PFS) and overall survival (OS) (R = 0.71, p = 0.009), but with a large confidence interval, suggesting strong heterogeneity in the inclusion criteria, HIPEC technique, and follow-up procedures
Summary
Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) has been used for ovarian cancer relapse since 2000, it is still not part of standard treatment [1].Historically, first line standard treatment with complete resection surgery and intravenous bi chemotherapy, +/− bevacizumab, fails to prevent the spread of this peritoneal tumor. Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) has been used for ovarian cancer relapse since 2000, it is still not part of standard treatment [1]. HIPEC is based on complete surgery followed by high concentration intraperitoneal chemotherapy enhanced with hyperthermic shock, resulting in homogeneous intraperitoneal diffusion [3]. In the context of ovarian cancer relapse, numerous retrospective and prospective studies, leading to reviews and meta-analyses, have bolstered support for HIPEC arguing that there are promising survival results in patients with recurrent ovarian cancer [4,5]. Hyperthermic intraperitoneal chemotherapy (HIPEC) is routinely used in the treatment of a first ovarian cancer relapse. Methods: This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, aimed to assess the quality of scientific proof of the survival benefits of HIPEC, using Medline and Google. Qualitative analysis using the Oxford CEBM Levels of Evidence 2011 grading is reported
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