Table 6. Studies describing the role of HIPEC in recurrent ovarian cancer.
HIPEC: hyperthermic intraperitoneal chemotherapy
| Study | Design | Inclusion criteria | Drugs | Results |
| Fagotti 2012 [17] | Case-control study: 30 cases CRS + HIPEC, 37 controls CRS alone | Platinum-sensitive recurrent ovarian cancer | Oxaliplatin 460 mg/m2, 41.5⁰C for 30 min, closed technique | Secondary recurrence 66.6% in cases, 100% in controls (P=0.001) |
| Bakrin 2012 [18] | Retrospective multicentric study (n=246) | Recurrent and persistant ovarian cancer treated with optimal CRS + HIPEC; Platinum-resistant persistant (n=62); Platinum-sensitive recurrent (n=184) | 95.5% received cisplatin alone or in combination with mitomycin C or doxorubicin, 90 minutes at 44⁰C-46⁰C, open and closed technique | Overall median survival: 48 months in platinum-resistant and 52 months in platinum-sensitive (P=0.568) |
| Spiliotis 2015 [23] | Randomized controlled trial: Secondary CRS + HIPEC + systemic chemotherapy (n= 60), Secondary CRS + systemic chemotherapy (n=60) | Stage IIIc & IV ovarian cancer with recurrence after debulking surgery followed by systemic chemotherapy | Platinum-sensitive: cisplatin 100 mg/m2 + paclitaxel 175 mg/m2; Platinum-resistant: doxorubicin 35 mg/m2 + paclitaxel 175 mg/m2 or mitomycin 15 mg/m2 60 min at 42.5⁰C; Open technique (n=40), Closed technique (n=20) | Mean overall survival: HIPEC: 26.7 months, No HIPEC: 13.4 months (P<0.006) |
| Le Brun 2014 [29] | Retrospective case-control study: CRS + HIPEC (n = 23), CRS alone (n =19) | Women with first ovarian cancer relapse receiving second-line chemotherapy followed by CRS | Cisplatin (n= 16): 16 mg/m2, eloxatin (n=6): 6 mg/m2, mitomycin C (n=1): 1 mg/m2, 42⁰C for 1 hour for cisplatin and 30 min for eloxatin and mitomycin C. | 4-year overall survival: CRS + HIPEC: 75.6%, CRS alone: 19.4 % (P=0.013) |
| Safra 2014 [30] | Case-control study: CRS+HIPEC (n=27), systemic chemotherapy alone (n= 84 ) | Recurrent epithelial ovarian cancer who underwent BRCA gene mutation testing | Cisplatin 50 mg/m2 and doxorubicin 15 mg/m2, Paclitaxel 60 mg/m2 and carboplatin, Cisplatin 25 mg/l/m2 and mitomycin-C 3.3 mg/l/m2 120 min at 42.5 ⁰C | Median progression-free survival rate: HIPEC: 15 months systemic chemotherapy: 6 months (P=0.001). 5-year survival rate 79% in CRS + HIPEC, 45% in systemic chemotherapy (P=0.016) |
| Baiocchi 2015 [33] | Retrospective observational study: Secondary cytoreduction alone (n=50), Secondary cytoreduction + HIPEC (n=29) | Platinum-sensitive recurrent ovarian cancer undergoing secondary cytoreduction | Mitomycin C (10 mg/m2) and cisplatin (50 mg/m2), Cisplatin (50 mg/m2) and doxorubicin (n=8), Cisplatin alone (50 mg/m2) (n=3), Closed technique 41⁰C-42⁰C for 90 min | Median overall survival: no HIPEC: 59.3 months, secondary cytoreduction with HIPEC: 58.3 months (P=0.95); Median disease-free survival: no HIPEC: 18.6 months, HIPEC + surgery: 15.8 months (P=0.82) |