Abstract
The standard treatment for advanced ovarian cancer consists in complete cytoreductive surgery (CRS) and intravenous combination chemotherapy with a platinum compound and a taxane. Although response rates to initial therapy are high, many patients will recur and die of peritoneal carcinomatosis. The addition of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) to the standard therapy aims at increasing survival by reducing peritoneal recurrence.
This review describes the survival results of HIPEC at the different time-points of the treatment of ovarian cancer: at upfront CRS, at interval CRS, at consolidation CRS after complete response to initial therapy, at secondary CRS after incomplete response, at salvage CRS for recurrence and as palliative treatment without CRS for unresectable ovarian cancer with chemotherapy resistant ascites.
The available evidence suggests that a potential survival benefit of adding HIPEC may be largest in the settings of secondary CRS for stage III ovarian cancer and salvage CRS for recurrent ovarian cancer, two time-points representing failure of initial standard therapy. There is much less evidence for a potential benefit of HIPEC for less advanced stages (I-II) and for earlier time-points in the treatment of ovarian cancer (upfront, interval and consolidation). Postoperative mortality is not higher after CRS and HIPEC (0.7%) than after CRS only (1.4%). Four randomised trials are ongoing and their results are eagerly awaited.
Palliative HIPEC without CRS might be used more in patients with incapacitating ascites due to recurrent ovarian cancer which has become resistant to systemic chemotherapy.
Keywords: Hyperthermic intraperitoneal chemotherapy (HIPEC), cytoreductive surgery, ovarian cancer, survival, time-points, review, peritoneal carcinomatosis, platinum compound, taxane, systemic chemotherapy.
Current Pharmaceutical Design
Title:Survival Benefit of Adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the Different Time-points of Treatment of Ovarian Cancer: Review of Evidence
Volume: 18 Issue: 25
Author(s): Stefaan Mulier, Jean-Pierre Claes, Vincent Dierieck, Jean-Olivier Amiel, Jean-Philippe Pahaut, Luc Marcelis, Fabienne Bastin, Denis Vanderbeeken, Claude Finet, Sophie Cran and Thierry Velu
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Keywords: Hyperthermic intraperitoneal chemotherapy (HIPEC), cytoreductive surgery, ovarian cancer, survival, time-points, review, peritoneal carcinomatosis, platinum compound, taxane, systemic chemotherapy.
Abstract: The standard treatment for advanced ovarian cancer consists in complete cytoreductive surgery (CRS) and intravenous combination chemotherapy with a platinum compound and a taxane. Although response rates to initial therapy are high, many patients will recur and die of peritoneal carcinomatosis. The addition of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) to the standard therapy aims at increasing survival by reducing peritoneal recurrence.
This review describes the survival results of HIPEC at the different time-points of the treatment of ovarian cancer: at upfront CRS, at interval CRS, at consolidation CRS after complete response to initial therapy, at secondary CRS after incomplete response, at salvage CRS for recurrence and as palliative treatment without CRS for unresectable ovarian cancer with chemotherapy resistant ascites.
The available evidence suggests that a potential survival benefit of adding HIPEC may be largest in the settings of secondary CRS for stage III ovarian cancer and salvage CRS for recurrent ovarian cancer, two time-points representing failure of initial standard therapy. There is much less evidence for a potential benefit of HIPEC for less advanced stages (I-II) and for earlier time-points in the treatment of ovarian cancer (upfront, interval and consolidation). Postoperative mortality is not higher after CRS and HIPEC (0.7%) than after CRS only (1.4%). Four randomised trials are ongoing and their results are eagerly awaited.
Palliative HIPEC without CRS might be used more in patients with incapacitating ascites due to recurrent ovarian cancer which has become resistant to systemic chemotherapy.
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Mulier Stefaan, Claes Jean-Pierre, Dierieck Vincent, Amiel Jean-Olivier, Pahaut Jean-Philippe, Marcelis Luc, Bastin Fabienne, Vanderbeeken Denis, Finet Claude, Cran Sophie and Velu Thierry, Survival Benefit of Adding Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) at the Different Time-points of Treatment of Ovarian Cancer: Review of Evidence, Current Pharmaceutical Design 2012; 18 (25) . https://dx.doi.org/10.2174/138161212802002616
DOI https://dx.doi.org/10.2174/138161212802002616 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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