Should we use the hyperthermic intraperitoneal chemotherapy in the management of ovarian cancer? A literature review

Abstract

Rationale: Epithelial ovarian cancer (EOC) is a relatively chemosensitive malignancy which begins, and most frequentlydisseminates by intraperitoneal seeding. Intraperitoneal chemotherapy (IP) is a route of drug delivery that allows the directinfusion of the chemotherapeutic agents into the peritoneal cavity. It has been proven to be efficient and with lower systemic sideeffects in comparison to the intravenous (IV) route. The combination between hyperthermia and intraperitoneal chemotherapy(Hyperthermic intraperitoneal chemotherapy) has a synergistic killing effect on the malignant cells and appears to be feasible inthe treatment of EOC. Objective: To review the current literature and discuss the use of HIPEC in the course of the EOC treatment: as first line medicaltreatment, at the time of cytoreductive surgery (CS), postoperative adjuvant IP chemotherapy and HIPEC, and for recurrentdisease focusing on the survival benefit, mortality rates, morbidity, adverse effects and limitations. Method: Medline, Pubmed, and the Cochrane Central Register of Controlled Trials (CENTRAL ) were investigated for Englishlanguage articles about the role of HIPEC in women with primary EOC, of any FIGO stage. The analysis was restricted toretrospective studies, randomized and nonrandomized controlled clinical trials, and gynecological oncology journals. The selectedinformation included data on feasibility, overall survival (OS), quality of life, and comparison with standard IV chemotherapy interms of complications, toxicity and anticancer effects. Conclusion: Hyperthermia of the IP chemotherapy solution increases the cytotoxicity of the drug in the peritoneal cavity andits systemic effects on the tumor peritoneal nodules. Although initial investigators presented encouraging survival outcomeswhen HIPEC was used in recurrent EOC, further studies are necessary in order to incorporate HIPEC as a front-line treatmentof EOC or as an adjuvant therapy. More research is required for defining the possible roles of HIPEC within the spectrum ofother treatments for EOC including repeated normothermic IP chemotherapy, early postoperative IP chemotherapy, and novel andbiological agents.