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Open Access Special Issue

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the Management of Advanced Ovarian Cancer. A Literature Review

  • Valentina Ghirardi1
  • Rita Trozzi1,2
  • Elena Giudice1,2
  • Giovanni Scambia1,2
  • Anna Fagotti1,2,*,

1Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, 00168 Rome, Italy

2Universita’ Cattolica del Sacro Cuore, 00151 Rome, Italy

DOI: 10.31083/j.ejgo4302039 Vol.43,Issue 2,April 2022 pp.335-340

Submitted: 27 December 2021 Accepted: 19 January 2022

Published: 15 April 2022

(This article belongs to the Special Issue Radical Surgery in Ovarian Cancer)

*Corresponding Author(s): Anna Fagotti E-mail:


The rationale behind the use of hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery is the association between pharmacological activity of chemotherapy delivered to the peritoneal cavity with the enhanced cytotoxic effect of hyperthermia. Data on the efficacy of HIPEC in the primary debulking surgery (PDS) setting are still controversial and limited by the small sample size of most of the studies, the inclusion of different treatment settings and chemotherapy regimens. Among the ongoing prospective trials, only the OVHIPEC-2 trial is investigating exclusively patients submitted to PDS ± HIPEC with cisplatin 100 mg/m22 and results are expected by 2026. On the interval debulking surgery (IDS) setting high quality data are coming from the result of the OVHIPEC-1 trial, which demonstrated a survival advantage of nearly 4 months in median progression-free survival (PFS) (14.2 months vs. 10.7 months; p = 0.003) and almost 12 months in median overall survival (OS) (45.7 months vs. 33.9 months; p = 0.02) for HIPEC treated patients (cisplatin 100 mg/m22) compared to no-HIPEC group, with comparable morbidity. However, due to some criticisms raised to the results of OVHIPEC-1 trial, the ESMO-ESGO guidelines recommended not to consider HIPEC as standard therapy until results from ongoing randomized control trials (RCTs) are provided. On the contrary, for the National Comprehensive cancer network (NCCN) guidelines HIPEC can be considered at the time of IDS. Similarly, data supporting the role of HIPEC in association with surgery in case of recurrent disease appear to be controversial in terms of patients and selection and intraperitoneal chemotherapy regimen. Indeed, despite the positive results coming from a prospective randomized trial, they appear to be biased by the inclusion of both platinum sensitive and resistant disease and the lack of information on PFS. Those results are in contrast with data coming from another prospective trial, which failed to demonstrate a survival gain of recurrent ovarian cancer patients treated with secondary cytoreductive surgery + HIPEC with carboplatin (800 mg/m22 for 90 min) compared to women submitted to cytoreduction only. Again, in this subgroup of patients data of ongoing RCTs are awaited to assess the impact on survival of HIPEC administration in case of recurrent disease.


ovarian cancer; HIPEC; primary debulking surgery; interval debulking surgery; recurrent disease

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Valentina Ghirardi,Rita Trozzi,Elena Giudice,Giovanni Scambia,Anna Fagotti. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the Management of Advanced Ovarian Cancer. A Literature Review. European Journal of Gynaecological Oncology. 2022. 43(2);335-340.


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