Authors' objectives: Assessing the efficacy and safety of hyperthermic intraperitoneal chemotherapy in combination with surgery in patients with ovarian cancer-derived peritoneal carcinomatosis.

Authors' recommendations: The level of scientific evidence on HIPEC in patients with ovarian-derived peritoneal carcinomatosis is moderate despite the abundant literature available. The primary studies identified were case-series studies, non-randomized intervention studies, and case-control studies. The studies included patients at various stages of their disease: primary treatment, interval treatment after neoadjuvant chemotherapy, consolidation treatment, secondary treatment after incomplete primary surgery and treatment of recurrent cancer (for first of subsequent recurrences, patients with relapses of varying intensity, patients with chemoresistant and chemosensitive cancer). There was also variability in the definition of the optimal cytoreduction cut-off value, as well as in the proportion of patients achieving it, the HIPEC technique employed and, therefore, in the overall efficacy outcomes obtained. The review revealed that there is more evidence on the potential benefit of HIPEC + Cytoreductive surgery in the treatment of recurrent cancer (mainly in chemosensitive patients receiving HIPEC after achieving optimal cytoreduction) as suggested by the higher number of patients assessed and the availability of comparative studies (despite their low level of evidence and moderate quality). Comparative studies assessing surgery + HIPEC vs. surgery alone obtained similar results. Statistically significant differences were observed in OS and DFS in favour of the groups treated with HIPEC. HIPEC-morbidity is mainly associated with surgical complications (paralytic ileus, anastomotic leakage, bleeding, wound infection, pleural effusion, pneumonia, and fistulas). The studies that provide outcomes for morbidity and systemic toxicity reported the following complication: anemia, neutropenia, thrombocytopenia, renal failure and hypokalemia. We identified ongoing randomized trials that will be useful to determine the role of HIPEC in the treatment of platinum-resistant patients with relapsed ovarian cancer (CHIPOR, NCT01767675, HORSE) after neoadjuvant chemotherapy (ECAs OVHIPEC and CHORINE), and in patients treated after incomplete primary surgery (OVHIPEC). To date, there are no completed randomized trials available assessing the efficacy of surgery + hyperthermic intraperitoneal chemotherapy in patients with ovarian cancer-derived peritoneal carcinomatosis, as compared to other therapeutic alternatives. Currently, definite conclusions cannot be drawn on the efficacy and safety of cytorreductive surgery + HIPEC for the treatment of ovarian cancer-derived peritoneal carcinomatosis.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/quimioterapia-intraperitoneal-hipertermica-eficacia-y-seguridad-en-el-tratamiento-de-la-carcinomatosis-peritoneal-del-cancer-de-ovario/

Year Published: 2013

URL for published report: https://www.aetsa.org/download/publicaciones/antiguas/AETSA_2012_6_HIPEC.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)