Selection of patients with ovarian cancer who may show survival benefit from hyperthermic intraperitoneal chemotherapy

Abstract

Background: The use of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been extensively studied in patients with peritoneal carcinomatosis from various malignancies. However, the effectiveness of HIPEC for ovarian cancer is still controversial. Therefore, we performed this meta-analysis to identify patients with ovarian cancer who can obtain survival benefit from HIPEC. Methods: Articles regarding HIPEC in the MEDLINE, EMBASE, and Cochrane Library were searched till December 2018. In total, 13 case-control studies and two randomized controlled trials were included in this meta-analysis. We investigated the effect of HIPEC on disease-free survival (DFS) and overall survival (OS), and performed subgroup analyses based on the study design, adjustment of confounding variables, and quality of the study. Results: HIPEC improved both DFS (hazard ratio [HR], 0.603; 95% confidence interval [CI], 0.513–0.709) and OS (HR, 0.640; 95% CI, 0.519–0.789). In cases of primary disease, HIPEC improved DFS (HR, 0.580; 95% CI, 0.476–0.706) and OS (HR, 0.611; 95% CI, 0.376–0.992). Subgroup analyses revealed that HIPEC did not improve OS but improved DFS of patients with residual tumors ≤1 cm or no visible tumors. In cases of recurrent disease, HIPEC was associated with better OS (HR, 0.566; 95% CI, 0.379–0.844) but not with DFS. Subgroup analyses also revealed similar tendencies. However, HIPEC improved DFS of patients with residual tumors ≤1 cm or no visible tumors, while it improved OS of only those with residual tumors ≤1 cm. Conclusions: HIPEC may improve DFS of patients with ovarian cancer when residual tumors were ≤1 cm or not visible. It may also improve OS of only patients with recurrent disease whose residual tumors were ≤1 cm.

Narrative review of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced ovarian cancer: a critical reappraisal of the current evidence

“…The outcomes of the meta-analysis by Kim et al for patients with primary disease showed an improved diseasefree survival (DFS) in patients who received HIPEC as part of CRS (5 studies, 630 patients, HR: 0.580, 95% CI: 0.476-0.706) when compared to no-HIPEC. Improved survival remained after subgroup analysis of study design, stage and adjustment for potential confounders (age, stage, NACT, grade, ECOG status and histology) (9). Additionally, the HIPEC groups showed improved OS compared to controls (5 studies, 591 patients, HR: 0.611, 95% CI: 0.376-0.992).…”

Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Epithelial Ovarian Cancer: A 20-Year Single-Center Experience

“…No consensus exists for a specific chemotherapy agent or protocol to be used, and evidence is currently limited to single institution experiences and retrospective studies. Systematic reviews confirmed that only OS is improved in patients with recurrent disease [ 7 , 8 , 9 ], but subgroup analysis revealed that HIPEC also improved DFS in patients who received optimal cytoreduction [ 22 ]. Five-year DFS and OS rates were 18% and 32%, respectively, in this series.…”

“…Five-year DFS and OS rates were 18% and 32%, respectively, in this series. HIPEC may overcome systemic resistance to platinum agents in this setting, but results are controversial and the question is open [ 22 , 25 , 29 , 30 ]. Prolonged NACT is believed to be a risk factor for platinum-resistance in selected histologic subtypes, which may give rise to a less sensitive recurrent disease [ 31 , 32 ].…”

Role of surgery and hyperthermic intraperitoneal chemotherapy in ovarian cancer

“…newly diagnosed or recurrent EOC) were different among the previous studies, which is also observed in ongoing clinical trials. 51 Thus, when, how, and on whom HIPEC should be carried out remains a significant issue.…”