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.