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It's time to warm up to hyperthermic intraperitoneal chemotherapy for patients with ovarian cancer

  • Oliver Zivanovic
    Correspondence
    Corresponding author at: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Dennis S. Chi
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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  • Olga Filippova
    Affiliations
    Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Leslie M. Randall
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
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  • Robert E. Bristow
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA
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  • Roisin E. O'Cearbhaill
    Affiliations
    Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Published:September 21, 2018DOI:https://doi.org/10.1016/j.ygyno.2018.09.007

      Highlights

      • HIPEC eliminates the time interval between cytoreduction and chemotherapy.
      • HIPEC at interval debulking surgery has shown a progression-free survival advantage.
      • Multiple studies show HIPEC is safe when performed at an expert center.

      Abstract

      The peritoneal spread of ovarian cancer makes it a potential target for hyperthermic intraperitoneal chemotherapy (HIPEC). Intraperitoneal delivery exposes the tumor to concentrations of cytotoxic drugs much greater than with intravenous delivery, and in vitro studies have also shown that combining hyperthermia and platinum leads to an additive cytotoxic effect. Pharmacokinetic analyses have confirmed very high concentrations of cytotoxic drugs in the peritoneal cavity, with minimal systemic exposure and toxicity.
      The majority of historical data evaluating HIPEC in ovarian cancer are based on retrospective research, which included heterogeneous groups of patients and drugs used for HIPEC. Recent publications on the findings of prospective studies, including the first randomized trial in which the only difference in intervention was the addition of HIPEC with cisplatin to interval debulking surgery in stage III patients, have shown a benefit in favor of HIPEC. Yet, a recent prospective study from Korea did not find a benefit.
      Opponents of HIPEC have cited higher rates of complications with this approach, yet most of the serious adverse events observed are likely related to the surgery itself, and are comparable to the rates reported in studies evaluating cytoreductive surgery without HIPEC. Findings from a recent randomized controlled trial showed no delays in initiation or completion of postoperative chemotherapy in patients treated with HIPEC.
      A growing body of evidence is indicating that it might be time to seriously consider HIPEC as a complementary treatment at the time of cytoreductive surgery for patients with advanced-stage ovarian cancer in the setting of an experienced center. Yet, more research is needed to identify the population of patients who gain the most benefit from this therapy.

      Keywords

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