Abstract 420P
Background
The introduction of hyperthermic intraperitoneal chemotherapy (HIPEC) was hoped to transform the management of peritoneal metastases, paving the way for pioneering research. Although, a plethora of published studies on the technique exist, conclusive results stemming from randomized data remain elusive. The aim of this study is to assess the cumulative comprehensive available evidence for the use vs non-use of HIPEC treatment in gastrointestinal and biliary tract (GI) malignancies and set the current standpoint of GI HIPEC research both for prevention (adjuvant) and treatment (metastatic) of peritoneal metastases.
Methods
Randomized controlled trials were identified through Medline, Cochrane and Embase databases systematic searches. When the number of eligible RCTs permitted it, a meta-analysis was conducted. Outcomes of interest were overall survival and progression-free survival.
Results
The search resulted in 13 RCTs for gastric cancer (10 of prophylactic HIPEC and 3 of therapeutic HIPEC), 4 for colorectal cancer (2 of prophylactic HIPEC and 2 of therapeutic HIPEC) and 1 for pancreatic cancer. No RCTs were detected that exclusively concerned appendiceal tumors, pseudomyxoma peritonei, malignant peritoneal mesothelioma, hepatobiliary tract malignancies and other cancer types. Current cumulative randomized data do not prove any survival advantage for the use of HIPEC vs non-use (gastric adjuvant RR= 1.11; 95% CI: 0.71-1.76; p = 0.642; colorectal adjuvant RR= 1.12; 95% CI: 0.70-1.80; p=0.635; colorectal metastatic RR= 0.88; 95% CI: 0.67-1.16; p=0.380). Despite survival benefit was evident in the treatment of peritoneal carcinomatosis from gastric cancer (RR= 0.85; 95% CI: 0.77-0.93, p= <0.001) results were driven from only 190 analyzed patients. Studies scrutinized unearthed notable methological issues and potential source of biases.
Conclusions
The current randomized data do not support the use of HIPEC in the treatment/prevention of peritoneal carcinomatosis in gastrointestinal and biliary tract malignancies, and its use should continue to be considered experimental until level one evidence data from properly planned international multicenter studies will be available.
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.