Original Title: Pertinence de la chimiothérapie intrapéritonéale pour prévenir ou traiter les néoplasies des surfaces péritonéales : métastases péritonéales secondaires à un cancer de l’ovaire

Authors' objectives: The Direction de la cancérologie of the ministère de la Santé et des Services sociaux (MSSS) has mandated the Institut national d’excellence en santé et en services sociaux (INESSS) to evaluate the clinical relevance of IP chemotherapy for the prevention or treatment of peritoneal metastases secondary to ovarian cancer, and to formulate recommendations, where appropriate, to support its optimal, equitable, and harmonized use across the Quebec healthcare network.

Authors' results and conclusions: RESULTS (#1 HEALTH NEEDS): Peritoneal dissemination is common (>70% at diagnosis) and is the main site of recurrence. (#2 CURRENT PRACTICE IN QUÉBEC): No comprehensive administrative or registry data allow characterization of HIPEC use in Québec. (#3 ASSESSMENT OF THE LEVEL OF SCIENTIFIC EVIDENCE): The selected studies are not readily comparable with one another and have certain methodological limitations (limited transferability, heterogeneity in followup, presence of confounding factors, insufficient statistical power for certain parameters) that must be taken into account when interpreting the results. (#4 EFFICACY, SAFETY AND QUALITY OF LIFE- PRIMARY CYTOREDUCTION): The consulted clinicians believe that current evidence does not demonstrate any clinical benefit associated with the administration of IP chemotherapy in the context of primary cytoreduction. (#4.1 EFFICACY, SAFETY AND QUALITY OF LIFE - INTERVAL CYTOREDUCTION FOLLOWING NEOADJUVANT CHEMOTHERAPY): In Quebec, HIPEC is performed almost exclusively in the context of interval cytoreduction. In practice, Quebec centers follow the OVHIPEC-01 study protocol, which involves cisplatin-based HIPEC combined with thiosulfate to reduce renal toxicity. (#4.2 EFFICACY, SAFETY AND QUALITY OF LIFE - SECONDARY CYTOREDUCTION FOLLOWING RECURRENCE): Available data suggest that the administration of HIPEC improves overall survival and does not increase grade ≥ 3 adverse events (including mortality) compared with the same intervention without HIPEC (level of evidence: high). However, data on quality of life remain limited (level of evidence: insufficient). (#5 ENVIRONMENTAL CONSIDERATIONS): The available data on the environmental impacts of HIPEC remain very limited. To date, no life cycle assessment of HIPEC in a hospital setting comparable to that of Quebec has been identified. Although the prolonged duration of surgery and the use of anesthetic gases are the main sources of GHG emissions associated with HIPEC, its specific environmental impact remains relatively marginal given the low volume of patients treated and the limited number of centers performing this procedure.

Authors' recommendations: In patients treated for peritoneal metastases of ovarian origin who undergo complete or optimal primary cytoreductive surgery: • the administration of cisplatin- or carboplatin-based EPIC is not recommended. In patients treated for peritoneal metastases of ovarian origin who undergo complete or optimal interval cytoreductive surgery following neoadjuvant therapy: when considered, the preferred treatment consists of administering 100 mg/m² of cisplatin heated to 42–43 °C, delivered as 50 mg/m² at the start of the procedure, 25 mg/m² at 30 minutes, and 25 mg/m² at 60 minutes, for a total duration of 90 minutes. In patients being treated for peritoneal metastases of ovarian origin who undergo complete or optimal secondary cytoreductive surgery following a recurrence: when considered, the preferred HIPEC protocol consists of administering cisplatin (100 mg/m²) heated to 40 °C for a total duration of 90 minutes.

Authors' methods: A systematic review of the literature was conducted to assess the clinical relevance of IP chemotherapy for the management of peritoneal metastases secondary to ovarian cancer. The literature reviewed included phase III randomized controlled trials (RCTs). In addition, a narrative review of the economic literature specifically focusing on clinically recognized indications was conducted. Consultations with clinicians were also carried out. A permanent deliberative committee supported the development of findings and recommendations following the completion of the work.

Authors' identified further research: The relevance of updating this opinion will be assessed and determined based on the availability of new data supporting any of the aspects evaluated in this statement, including the publication of studies, systematic reviews, meta-analyses, recommendations from international organizations, or national regulations.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Oncologie/CHIP_Cancer_ovaire_avis_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)