The peritoneal surface is a common site of disease in ovarian and colorectal cancer. Peritoneal metastases carry a poor prognosis, despite maximal therapeutic efforts, including surgical removal of tumor deposits and intravenous chemotherapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a single intraoperative procedure that delivers chemotherapy directly into the abdominal cavity, leading to high intracellular drug concentration at the peritoneal surface. This review describes the current knowledge regarding the mechanism of action, safety, and efficacy of HIPEC in the treatment of peritoneal metastases from epithelial ovarian and colorectal cancers and explores current knowledge gaps.
Toxic effects of HIPEC are limited. Evidence from a randomized trial shows improved recurrence-free and overall survival after HIPEC in patients with ovarian cancer who are ineligible for primary cytoreductive surgery (CRS). The effect of HIPEC for patients with ovarian cancer undergoing primary CRS or CRS for recurrent disease has not yet been determined, and results of ongoing trials must be awaited. A recent study in patients with peritoneal metastases from colorectal cancer did not show a benefit of HIPEC when added to perioperative chemotherapy.
Conclusions and Relevance
Based on available evidence, various international guidelines include the option to add HIPEC to interval CRS for patients with stage III ovarian cancer. The role of HIPEC in colorectal cancer is less well defined. Future studies will need to tailor patient selection, timing, and optimal regimens of HIPEC to improve the effectiveness of this specialized treatment in ovarian, colorectal, and other tumor types.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: February 1, 2021.
Published Online: May 6, 2021. doi:10.1001/jamaoncol.2021.0580
Corresponding Author: Willemien J. van Driel, MD, PhD, Center for Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands (firstname.lastname@example.org).
Author Contributions: Drs van Stein and van Driel had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: van Stein, Aalbers, Sonke.
Acquisition, analysis, or interpretation of data: van Stein, Aalbers, van Driel.
Drafting of the manuscript: van Stein, Aalbers.
Critical revision of the manuscript for important intellectual content: Aalbers, Sonke, van Driel.
Administrative, technical, or material support: van Stein, Aalbers.
Supervision: Aalbers, Sonke, van Driel.
Conflict of Interest Disclosures: Dr Sonke reported receiving institutional research support from AstraZeneca, Merck & Co, Inc, Novartis AG, and F. Hoffman–La Roche Ltd outside the scope of this review. No other disclosures were reported.
Additional Contributions: The Figure is reprinted with permission from LMC Vos, Netherlands Cancer Institute, all rights reserved.
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