There is no role for hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer

Hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of ovarian cancer

“…Strengths of this study, compared with the Dutch study, were intra-operative randomisation, bowel anastomosis prior to randomisation and inclusion of patients with stage IV disease, allowing better generalisability of findings. 25 The van Driel study used sodium thiosulphate for renal protection, and when given in the Korean study, there were no additional toxicities found in relation to HIPEC. With regard to histological subtype, both the Dutch and Korean studies included all epithelial ovarian subtypes but found greatest benefit in patients with high grade serous histology.…”

“…There was also a suspicion that toxicities were under-reported, as these were low. 25 However, criticisms that the study analysis changed during the trial, of histological imbalance between the two groups and with regard to surgical experience have since been refuted. 25,26 A further randomised controlled trial (RCT) conducted in Korea has now shown similar results to the van Driel study.…”

“…25 However, criticisms that the study analysis changed during the trial, of histological imbalance between the two groups and with regard to surgical experience have since been refuted. 25,26 A further randomised controlled trial (RCT) conducted in Korea has now shown similar results to the van Driel study. 27 The study protocol was cisplatin 75 mg/m 2 at 41.5°C for 90 minutes.…”

“…This study has subsequently been criticised for its small size (245 patients), exclusion of stage IV disease, a protocol of pre‐operative rather than intra‐operative randomisation and higher rates of stoma formation in the HIPEC group. There was also a suspicion that toxicities were under‐reported, as these were low 25 …”

How should randomized controlled trials in epithelial ovarian cancer be interpreted?

“…The authors refrain from discussing these differences in the context of their results. This is remarkable, as the same group of authors previously emphasized that an equivalent discrepancy in the distribution of histological subtypes in the OVHIPEC-1 trial published by Van Driel and colleagues4 may have biased their outcomes 5 6. In the OVHIPEC-1 trial, the percentages of low-grade serous ovarian cancer, clear cell carcinoma, carcinosarcoma and high-grade serous ovarian cancer between the surgery alone versus the surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) group were 2% versus 3%, 4% versus 0%, 3% versus 1%, and 87% versus 92%, respectively.…”