Abstract 540P
Background
Ovarian cancer is the most lethal gynecologic malignancy. Although treatment with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promising results, its role remains elusive. Aim: To assess the comprehensive randomized evidence for the use vs non-use of HIPEC in primary (POC) and recurrent (ROC) ovarian cancer.
Methods
The Medline, Embase and Cochrane databases, as well as the ESMO and ASCO conference abstracts of the last 5 years, were systematically searched in January 2022 for randomized controlled trials (RCTs) that studied the use of HIPEC in ovarian cancer. Overall survival (OS), disease-(DFS) and progression-free survival (PFS) was calculated and analyzed in different time-points of follow-up (1-, 2-, 3-, 4-, 5-year OS/DFS/PFS). Data on postoperative morbidity and mortality were also analyzed. RoB 2 Cochrane tool was utilized to assess the risk of bias of the included RCTs.
Results
Six RCTs randomizing 737 patients were included in our analysis, of these four studies (519 patients) pertained primary and two (218 patients) recurrent settings. In primary ovarian cancer the combination of HIPEC with interval cytoreductive surgery (CRS) and neoadjuvant chemotherapy significantly improved the 5-year OS (RR=0,77;95%CI:0,67-0,90;p-value=0,001) and DFS (HR=0,60;95%CI:0,41-0,87;p-value=0,008) compared with standard treatment alone. In the absence of neoadjuvant chemotherapy the use of HIPEC+CRS was not associated to any survival advantage (4-year OS, RR=0,93;95% CI:0,57-1,53;p-value=0,781). Use of HIPEC in recurrent ovarian cancer did not provide any survival advantage (5-years OS: RR=0,85; 95% CI=0,45-1,62; p-value=0,626). The risk for grade three or higher adverse events was similar between HIPEC and no HIPEC (RR=1,08;95%CI:0,98-1,18;p-value=0,109).
Conclusions
In primary ovarian cancer the combination of HIPEC with interval cytoreductive surgery and neoadjuvant chemotherapy is a safe and reliable treatment option that significantly improved 5-year OS and DFS. In the other settings its use should continue to be considered investigational.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.