Prolonged Exposition with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) May Provide Survival Benefit after Cytoreductive Surgery (CRS) in Advanced Primary Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

Abstract

Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, 37, 62, and 25 patients were enrolled into the HIPEC with/without neoadjuvant chemotherapy (upfront vs. interval) and into the 60 min and 90 min long HIPEC groups, respectively. Better overall survival (OS) was observed in the 90 min HIPEC group (p = 0.0330), compared to the 60 min HIPEC group. Neither OS (p = 0. 2410), disease-specific (p = 0. 3670), nor recurrence-free survival (p = 0.8240) differed between upfront and interval HIPEC. Higher peritoneal carcinomatosis index (PCI) values were associated with worse disease-specific survival (p = 0.0724). Age (p = 0.0416), body mass index (p = 0.0044), PCI (p < 0.0001), the type (p = 0.0016) and duration (p = 0.0012) of HIPEC, and increased perioperative morbidity (p < 0.0041) had the greatest impact on OS. Conclusions: Increasing data support the value of HIPEC in the treatment of advanced ovarian cancer. Ongoing prospective studies will definitively clarify the role and timing of this additional therapeutic approach.

Current clinical practices of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

“…One of the main bottlenecks of HIPEC research and consequently in the interpretation and comparison of the result is the remarkable heterogeneity and variety of HIPEC parameters (open vs. closed techniques, dosage of chemotherapeutics, timing of therapy and duration) among centers worldwide [ 90 ]. However, there is growing evidence that prolonged exposure time in the peritoneal cavity is not associated with increased morbidity and may contribute prolong survival [ 90 , 91 ].…”

Standardizing Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer Treatment: Navigating Complexities and Charting the Path Forward

“…In response to these challenges, significant efforts are underway. The study by Acs et al [4], comparing HIPEC application times of 60 and 90 min, with superior results at longer exposure times, seeks to contribute valuable evidence toward standardizing HIPEC application in Advanced Primary Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer. Additionally, the work of Horvath et al [5] corroborates the validity of 90 min HIPEC with cisplatin as monotherapy, specifically in the case of Peritoneal Recurrence of Platinum-Sensitive Recurrent Ovarian Cancer.…”