Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis

Eur J Surg Oncol. 2015 Dec;41(12):1578-89. doi: 10.1016/j.ejso.2015.08.172. Epub 2015 Sep 25.

Abstract

Purpose: Emerging evidence suggests that hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery (CRS) shows a survival benefit over CRS alone for patients with epithelial ovarian carcinoma (EOC). This systematic review and meta-analysis will assess the safety and efficacy of HIPEC with CRS for EOC.

Design: Searches of five databases from inception to 17/02/15 was performed. Clinical outcomes were synthesised, with full tabulation of results.

Results: A total of 9 comparative studies and 28 studies examining HIPEC + CRS for primary and/or recurrent EOC were included. Meta-analysis of the comparative studies showed HIPEC + CRS + chemotherapy had significantly better 1-year survival compared with CRS + chemotherapy alone (OR: 3.76, 95% CI 1.81-7.82). The benefit of HIPEC + CRS continued for 2-, 3-, 4-, 5- and 8-year survival compared to CRS alone (OR: 2.76, 95% CI 1.71-4.26; OR: 5.04, 95% CI 3.24-7.85; OR: 3.51, 95% CI 2.00-6.17; OR: 3.46 95% CI 2.19-5.48; OR: 2.42, 95% 1.38-4.24, respectively). Morbidity and mortality rates were similar. Pooled analysis of all studies showed that among patients with primary EOC, the median, 1-, 3-, and 5-year overall survival rates are 46.1 months, 88.2%, 62.7% and 51%. For recurrent EOC, the median, 1-, 3-, and 5-year overall survival rates are 34.9 months, 88.6%, 64.8% and 46.3%. A step-wise positive correlation between completeness of cytoreduction and survival was found.

Conclusion: The addition of HIPEC to CRS and chemotherapy improves overall survival rates for both primary and recurrent EOC.

Keywords: CRS; Cytoreductive surgery; HIPEC; Hyperthermic intraperitoneal chemotherapy; Meta-analysis; Ovarian cancer; Review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Cytoreduction Surgical Procedures / methods*
  • Female
  • Humans
  • Hyperthermia, Induced / methods*
  • Ovarian Neoplasms / therapy*

Substances

  • Antineoplastic Agents