HIPEC For ovarian cancer in clinical practice

Ovarian cancer is the third most common and deadliest gynecologic cancer. The lack of specific symptoms often leads to delayed diagnosis and advanced disease with extensive peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique in which heated chemotherapy is delivered into the abdominal cavity after cytoreductive surgery (CRS) to treat microscopic disease on the peritoneum. The OVHIPEC-1 trial demonstrated improved survival when interval CRS was combined with HIPEC for stage III epithelial ovarian cancer.
A three-year implementation phase aimed at facilitating the safe and widespread use of HIPEC in the Netherlands. This thesis comprehensively describes the initiatives and factors relevant to the translation of the OVHIPEC-1 results into clinical practice. These included training of medical teams, patient education and assessment of patient HRQoL. Our efforts also aimed to standardize and improve preoperative assessment, patient selection, HIPEC and CRS administration, and postoperative care. Real-world results demonstrate the safety, feasibility, and growing acceptance of HIPEC, with preliminary analyses suggesting a survival benefit.
HIPEC has been established as a viable treatment for patients undergoing interval CRS, but its efficacy in patients undergoing primary CRS remains undetermined. The ongoing OVHIPEC-2 trial will enroll 538 patients with stage III epithelial ovarian cancer eligible for primary CRS and is expected to complete enrollment in 2025. Other knowledge gaps include the role of HIPEC in the recurrent setting, the optimal delivery protocol and perioperative care, the independent or synergistic effects of HIPEC with other treatments, and the potential of biomarkers to predict benefit from HIPEC.