July 13, 2023 Author : João Casanova Hyperthermic intraperitoneal chemotherapy , better known as HIPEC , is a treatment option that may be indicated in cases of cancer with peritoneal metastasis. The objective is to eliminate microscopic disease, thus complementing cytoreductive surgery, in which visible disease is removed. In HIPEC, cytotoxic drugs (chemotherapy) are administered into the peritoneal cavity at a temperature higher than normal (hyperthermia). HIPEC is performed at the same time, but after the cytoreductive surgery . Hyperthermia potentiates the effects of administered drugs and can also induce other antitumoral responses, related or not specifically to the primary tumor, some of which are still not fully understood. HIPEC is usually performed when cytoreductive surgery is performed with an open approach. Warmed saline solution and chemotherapy drugs are perfused into the peritoneal cavity, and a local temperature of 40 o C-43 o C is reached. The temperature in the rest of the body is maintained within normal values using specific intravenous fluid therapy, blankets and cooling packs. Despite the results obtained so far, the role of HIPEC in the treatment of ovarian cancer is not yet fully defined . HIPEC results in ovarian cancer The results achieved with HIPEC in patients with ovarian carcinoma (high-grade serous carcinoma), which represents around 85%-90% of cases of primary cancer of this organ, have not always been concordant and are influenced by several factors: They are related to previous treatments, the degree of disease progression, repetition of HIPEC, other subsequent chemotherapy treatments and even biological variations of tumors, including mutations in the BRCA genes. In recent reviews of the results of published studies it was found: In approximately 600 patients, a significant improvement in the disease-free period and overall survival in patients undergoing HIPEC and cytoreductive surgery, performed after neoadjuvant chemotherapy treatments (prior to surgery) compared to patients who did not undergo neoadjuvant chemotherapy, in which HIPEC has not been shown to have an advantage. Other studies have revealed contradictory results of HIPEC and cytoreductive surgery, in a situation of disease relapse, compared to patients undergoing only intravenous chemotherapy. At this date, some guidelines for the management of the disease (for example, those of the National Comprehensive Cancer Network, NCCN) indicate that HIPEC may be an option after cytoreductive surgery in patients with FIGO stage III ovarian carcinoma who received neoadjuvant chemotherapy with a favorable response. In other cases, such as the European Society for Medical Oncology guidelines, HIPEC is not considered as first-line treatment and should be reserved for patients included in clinical trials. The use of HIPEC in ovarian carcinoma thus remains an important area of investigation. Several clinical trials are currently underway with expected completion dates for the next 5 years, in different parts of the world, which intend to clarify several questions that remain not answered . References Filis P, Mauri D, Markozannes G, Tolia M, Filis N, Tsilidis K. Hyperthermic intraperitoneal chemotherapy (HIPEC) for the management of primary advanced and recurrent ovarian cancer: a systematic review and meta-analysis of randomized trials. ESMO Open 2022;7:100586. doi: 10.1016/j.esmoop.2022.100586. Gadducci A, Cosio S, Lippolis PV. Hyperthermic intraperitoneal chemotherapy in the management of primary epithelial ovarian cancer: A debated issue for gynecologic oncologists. Anticancer Res 2022;42:4659-4665. doi: 10.21873/anticanres.15970. Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
