Role of hyperthermic intraperitoneal chemotherapy in ovarian cancer

Abstract

Epithelial ovarian cancer (EOC), has the highest worldwide mortality of all gynecological tumors, in 75% of cases is diagnosed in advanced stages. Despite of treatments with maximal cytoreductive surgery (CRS) and platinum-based chemotherapy (CT), approximately 70% of patients with advancedstage disease relapse within 18 months, given this high number of recurrences, new approaches are needed to improve outcomes for these patients. Hyperthermic intraperitoneal chemotherapy (HIPEC) has fundamentally changed the treatment of patients with ovarian cancer, with complete CRS and locoregional administration of chemotherapy. The purpose of this review is to find the most relevant, reliable published evidence of the use of HIPEC in ovarian cancer, together with an overview of peritoneal carcinomatosis (PC), procedures, therapeutic approaches in first-line and recurrent disease, the benefit of hyperthermia, selection of the ideal patient for the HIPEC procedures as well to analyze the disease free survival (DFS), morbidity, mortality and overall survival (OS) in patients with ovary cancer. So far, the small amount of evidence points favorably to the use of CRS and HIPEC as a first line of therapy, but more prospective randomized trials are needed to officially adopt this procedure as a standard of care, additionally patients need to know this option exists.

Folate Receptor Targeted Photodynamic Therapy: A Novel Way to Stimulate Anti-Tumor Immune Response in Intraperitoneal Ovarian Cancer

“…The addition of Poly(ADP-ribose) polymerase inhibitors (PARP) and anti-angiogenic agents to conventional treatments has significantly increased the progression free survival (PFS) of these patients [35][36][37]. However, despite major advances in the management of this cancer, 70% of patients in remission will relapse within 18 months [38]. This suggests that microscopic peritoneal metastases may be not eradicated or controlled by the standard care [18].…”

No obvious advantage of hyperthermic intraperitoneal chemotherapy after interval debulking surgery in the treatment of advanced ovarian cancer: A retrospective study

“…Chemotherapy drugs used in HIPEC in published studies differed and contained multiple types, including cisplatin, paclitaxel, and doxorubicin ( 26 , 33 ). Cisplatin has been used more often and is recommended in the NCCN guidelines.…”

Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

“…IP chemotherapy takes advantage of the blood–peritoneal barrier to achieve a much higher drug concentration at the peritoneal surface [ 107 , 108 , 109 , 110 ]. The addition of hyperthermia to IP chemotherapy implies the thermal enhancement of the chemotherapeutic agents used, increased drug uptake in malignant cells secondary to increased membrane permeability, inhibits repair mechanisms, facilitates lysosomal enzyme activation and selectively improves vascular flow in normal cells [ 18 , 111 , 112 ].…”