Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in Ovarian Cancer: An Umbrella Review of Meta-Analyses

Abstract

BackgroundThe utility of heated intraperitoneal chemotherapy (HIPEC) in the management of epithelial ovarian cancer (EOC) has been assessed in several randomised clinical trials and meta-analyses, and it is still a subject of controversy. Therefore, we performed an umbrella review of existing meta-analyses to summarise the outcomes of HIPEC and cytoreductive surgery (CRS) association in ovarian cancer.MethodsWe examined the MEDLINE, Cochrane Library, Scopus, Prospero, Web of Science and Science Direct from inception to May 30, 2020, for meta-analyses of randomised controlled trials and observational studies. Analyses of overall survival, disease free survival and progression survival were performed separately for primary and recurrent ovarian cancers.ResultsWe identified 6 meta-analyses investigating the association of HIPEC with CRS in the management of ovarian cancer. Three year overall survival was significantly improved by the association of CRS and HIPEC for primary (HR: 0.66, 95%CI:0.56-0.78) and recurrent ovarian cancers (HR:0.50, 95%CI:0.38-0.64). This benefit was also demonstrated on disease-free survival for primary (HR: 0.54, 95%CI:0.48-0.61) and recurrent ovarian cancer (HR: 0.60, 95%CI:0.46-0.78). The pooled hazard ratios confirmed the advantage of HIPEC and CRS association with respect to CRS alone on progression free survival for primary and recurrent ovarian cancer respectively with HR: 0.50, 95%CI: 0.43-0.58 and HR: 0.59, 95%CI: 0.41-0.85.ConclusionWhile waiting for the results of the current prospective studies, the present umbrella study suggests that HIPEC performed at the end of CRS may be a complementary effective asset for ovarian cancer patient management.

Hyperthermic intraperitoneal chemotherapy (HIPEC) for the management of primary advanced and recurrent ovarian cancer: a systematic review and meta-analysis of randomized trials

“…A recent umbrella review of meta-analyses, involving data mainly from cohort studies, highlighted that HIPEC research in ovarian cancer seems promising and underscored the need of evidence from prospective randomized trials. 35 This is the first systematic review and meta-analysis that depicts the available level I evidence data for the use versus no use of HIPEC in patients with ovarian cancer. Only randomized trials were included, many of which were recently published, and the two different settings of advanced primary ovarian cancer and recurrent ovarian cancer were separately analyzed, both for safety and efficacy.…”

“…A recent umbrella review of meta-analyses, involving data mainly from cohort studies, highlighted that HIPEC research in ovarian cancer seems promising and underscored the need of evidence from prospective randomized trials. 35 …”

Beware of lethal Wernicke's encephalopathy after cytoreductive surgery with HIPEC for peritoneal pseudomyxoma: Case report of morbidity and mortality review

“…CRS-HIPEC is the established treatment not only for ovarian cancer [20] but also PMP originating from the appendix. Its positive effect on overall and disease-free survival has been proven in literature [21] .…”

Is there a role for hyperthermic intraperitoneal chemotherapy in ovarian cancer?

“…Enhanced recovery after surgery is used postoperatively, and patients are cared for on the routine surgical floor. Other institutions have published guides to starting HIPEC protocols, most of which focus on perioperative care and considerations, as well as the multidisciplinary work needed to achieve a safe and efficacious HIPEC case [33–35,36 ▪ ,37–41].…”