Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the treatment of advanced ovarian cancer: A literature review

Abstract

Relevance: Epithelial ovarian cancer remains one of the leading causes of mortality among gynecological malignancies, particularly in stages III-IV, when peritoneal spread is detected in the majority of patients. Despite advances in surgery and systemic chemotherapy, more than 70% of patients develop recurrence. In this context, hyperthermic intraperitoneal chemotherapy (HIPEC) combined with cytoreductive surgery (CRS) is being actively investigated.

The study aimed to summarize and critically analyze the current evidence on the efficacy, safety, and indications for HIPEC in advanced and recurrent ovarian cancer to determine the HIPEC role in clinical practice.

Methods: Publications from the last 10-15 years (PubMed, Scopus, clinicaltrials.gov) were reviewed, including randomized controlled trials, meta-analyses, as well as prospective and retrospective series.

Results: The strongest evidence comes from studies demonstrating that the use of HIPEC during interval cytoreduction improves progression-free and overall survival in patients with advanced ovarian cancer. Several large trials have also reported improved overall survival in patients with a first platinum-sensitive recurrence; however, other randomized trials have failed to confirm these findings, highlighting the need for further clarification of patient selection criteria.

Conclusion: HIPEC appears to be a promising addition to standard therapy, especially in patients with stage III epithelial ovarian cancer and those with platinum-sensitive recurrences. Limiting factors include high toxicity, the lack of standardized protocols, and substantial costs.