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

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 effica...

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Bibliographic Details
Published in:European journal of surgical oncology 2015-12, Vol.41 (12), p.1578-1589
Main Authors: Huo, Y.R, Richards, A, Liauw, W, Morris, D.L
Format: Article
Language:English
Subjects:
Antineoplastic Agents - therapeutic use
CRS
Cytoreduction Surgical Procedures - methods
Cytoreductive surgery
Female
Hematology, Oncology and Palliative Medicine
HIPEC
Humans
Hyperthermia, Induced - methods
Hyperthermic intraperitoneal chemotherapy
Meta-analysis
Ovarian cancer
Ovarian Neoplasms - therapy
Review
Surgery
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Summary: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.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2015.08.172