Skip to main content
SpringerLink
Log in

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

  • Review article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. van Driel WJ, Lok CAR, Verwaal V, Sonke GS. The role of hyperthermic intraperitoneal intraoperative chemotherapy in ovarian cancer. Curr Treat Options Oncol. 2015;16:14. https://doi.org/10.1007/s11864-015-0329-5.

    Article  PubMed  Google Scholar 

  2. Muñoz-Casares FC, Medina-Fernández FJ, Arjona-Sánchez Á, et al. Peritonectomy procedures and HIPEC in the treatment of peritoneal carcinomatosis from ovarian cancer: long-term outcomes and perspectives from a high-volume center. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2016;42:224–33. https://doi.org/10.1016/j.ejso.2015.11.006.

    Article  Google Scholar 

  3. Boisen MM, Richard SD, Holtzman MP, et al. Hyperthermic intraperitoneal chemotherapy for epithelial ovarian cancers: is there a role? J Gastrointest Oncol. 2016;7:10–7. https://doi.org/10.3978/j.issn.2078-6891.2015.103.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Massari R, Barone M, Basilico R, et al. Peritonectomy and hyperthermic chemotherapy in patients with advanced or recurrent ephitelial ovarian cancer: a single center cohort study. Minerva Chir. 2014;69:17–26.

    CAS  PubMed  Google Scholar 

  5. Roviello F, Pinto E, Corso G, et al. Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol. 2010;102:663–70. https://doi.org/10.1002/jso.21682.

    Article  PubMed  Google Scholar 

  6. Magge D, Ramalingam L, Shuai Y, et al. Hyperthermic intraperitoneal chemoperfusion as a component of multimodality therapy for ovarian and primary peritoneal cancer. J Surg Oncol. 2017;116:320–8. https://doi.org/10.1002/jso.24666.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Polom K, Roviello G, Generali D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for treatment of ovarian cancer. Int J Hyperth. 2016;32:298–310. https://doi.org/10.3109/02656736.2016.1149233.

    Article  CAS  Google Scholar 

  8. Bhatt A, Glehen O. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer: a review. Indian J Surg Oncol. 2016;7:188–97. https://doi.org/10.1007/s13193-016-0501-9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cowan RA, O’Cearbhaill RE, Zivanovic O, Chi DS. Current status and future prospects of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) clinical trials in ovarian cancer. Int J Hyperth Off J Eur Soc Hyperth Oncol North Am Hyperth Group. 2017;33:548–53. https://doi.org/10.1080/02656736.2017.1283066.

    Article  Google Scholar 

  10. Gonzalez Bayon L, Steiner MA, Vasquez Jimenez W, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of advanced epithelial ovarian carcinoma: upfront therapy, at first recurrence, or later? Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2013;39:1109–15. https://doi.org/10.1016/j.ejso.2013.06.022.

    Article  CAS  Google Scholar 

  11. Sleightholm R, Foster JM, Smith L, et al. The American Society of Peritoneal Surface Malignancies Multi-Institution evaluation of 1,051 advanced ovarian cancer patients undergoing cytoreductive surgery and HIPEC: an introduction of the peritoneal surface disease severity score. J Surg Oncol. 2016;114:779–84. https://doi.org/10.1002/jso.24406.

    Article  PubMed  Google Scholar 

  12. Gouy S, Ferron G, Glehen O, et al. Results of a multicenter phase I dose-finding trial of hyperthermic intraperitoneal cisplatin after neoadjuvant chemotherapy and complete cytoreductive surgery and followed by maintenance bevacizumab in initially unresectable ovarian cancer. Gynecol Oncol. 2016;142:237–42. https://doi.org/10.1016/j.ygyno.2016.05.032.

    Article  CAS  PubMed  Google Scholar 

  13. Deraco M, Kusamura S, Virzì S, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol. 2011;122:215–20. https://doi.org/10.1016/j.ygyno.2011.05.004.

    Article  PubMed  Google Scholar 

  14. Tangjitgamol S, Manusirivithaya S, Laopaiboon M, et al. Interval debulking surgery for advanced epithelial ovarian cancer. Cochrane Database Syst Rev. 2016;1:7. https://doi.org/10.1002/14651858.cd006014.pub7.

    Article  Google Scholar 

  15. Sun J-H, Ji Z-H, Yu Y, et al. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy to treat advanced/recurrent epithelial ovarian cancer: results from a retrospective study on prospectively established database. Transl Oncol. 2016;9:130–8. https://doi.org/10.1016/j.tranon.2016.02.002.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kocic M, Nikolic S, Zegarac M, et al. Prognostic factors and outcomes of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer—a single tertiary institution experience. J BUON Off J Balk Union Oncol. 2016;21:1176–83.

    Google Scholar 

  17. Tentes A-AK, Kakolyris S, Kyziridis D, Karamveri C. Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy in the treatment of advanced epithelial ovarian cancer. J Oncol. 2012;2012:358341. https://doi.org/10.1155/2012/358341.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Arjona-Sanchez A, Rufián-Peña S. Progress in the management of primary and recurrent ovarian carcinomatosis with peritonectomy procedure and HIPEC in a high volume centre. Int J Hyperth Off J Eur Soc Hyperth Oncol North Am Hyperth Group. 2017;33:554–61. https://doi.org/10.1080/02656736.2017.1278631.

    Article  Google Scholar 

  19. Di Giorgio A, De Iaco P, De Simone M, et al. Cytoreduction (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: retrospective italian multicenter observational study of 511 cases. Ann Surg Oncol. 2017;24:914–22. https://doi.org/10.1245/s10434-016-5686-1.

    Article  PubMed  Google Scholar 

  20. Manzanedo I, Pereira F, Pérez-Viejo E, et al. Hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with primary or secondary cytoreductive surgery in the treatment of advanced epithelial ovarian cancer. Minerva Ginecol. 2017;69:119–27. https://doi.org/10.23736/S0026-4784.16.03959-9.

    Article  PubMed  Google Scholar 

  21. Coccolini F, Campanati L, Catena F, et al. Hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel in advanced ovarian cancer: a multicenter prospective observational study. J Gynecol Oncol. 2015;26:54–61. https://doi.org/10.3802/jgo.2015.26.1.54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Bakrin N, Bereder JM, Decullier E, et al. Peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced ovarian carcinoma: a French multicentre retrospective cohort study of 566 patients. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol. 2013;39:1435–43. https://doi.org/10.1016/j.ejso.2013.09.030.

    Article  CAS  Google Scholar 

  23. Helm CW, Richard SD, Pan J, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: first report of the HYPER-O registry. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2010;20:61–9. https://doi.org/10.1111/IGC.0b013e3181c50cde.

    Article  Google Scholar 

  24. Cascales-Campos P, López-López V, Gil J, et al. Hyperthermic intraperitoneal chemotherapy with paclitaxel or cisplatin in patients with stage III-C/IV ovarian cancer. Is there any difference? Surg Oncol. 2016;25:164–70. https://doi.org/10.1016/j.suronc.2016.05.010.

    Article  CAS  PubMed  Google Scholar 

  25. Armstrong DK, Bundy B, Wenzel L, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34–43. https://doi.org/10.1056/NEJMoa052985.

    Article  CAS  PubMed  Google Scholar 

  26. Sánchez-García S, Villarejo-Campos P, Padilla-Valverde D, et al. Intraperitoneal chemotherapy hyperthermia (HIPEC) for peritoneal carcinomatosis of ovarian cancer origin by fluid and CO2 recirculation using the closed abdomen technique (PRS-1.0 Combat): a clinical pilot study. Int J Hyperth. 2016;32:488–95. https://doi.org/10.3109/02656736.2016.1152515.

    Article  CAS  Google Scholar 

  27. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol. 2009;112:265–74. https://doi.org/10.1016/j.ygyno.2008.08.033.

    Article  PubMed  Google Scholar 

  28. van Driel WJ, Koole SN, Sikorska K, et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med. 2018;378:230–40. https://doi.org/10.1056/NEJMoa1708618.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aarhus University Hospital, Aarhus, Denmark

    Samira Zirak-Schmidt

  2. Colorectal Surgeon Aarhus University, Aarhus, Denmark

    Victor J. Verwaal

  3. Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

    Victor J. Verwaal

Authors
  1. Samira Zirak-Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Victor J. Verwaal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor J. Verwaal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zirak-Schmidt, S., Verwaal, V.J. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) as Primary Treatment of Ovarian Cancer: A Review of the Current Literature. Indian J Gynecol Oncolog 16, 54 (2018). https://doi.org/10.1007/s40944-018-0218-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-018-0218-5

Keywords

Search

Navigation