The Peritoneal Paradox: Deciphering the Conflicting Evidence for HIPEC in Primary Versus Recurrent Ovarian Cancer

Abstract

Advanced-stage ovarian cancer is characterized by high mortality and frequent peritoneal recurrence. “Hyperthermic Intraperitoneal Chemotherapy” (HIPEC), which delivers heated chemotherapeutic agents directly into the peritoneal cavity following cytoreductive surgery (CRS), aims to enhance local cytotoxicity against microscopic residual disease. A comprehensive Boolean search was conducted using PubMed/Medline, Google Scholar, Embase and Scopus to identify relevant studies on the use of HIPEC for primary and recurrent ovarian cancer. Evidence from randomized controlled trials (RCTs) indicates that HIPEC significantly improves overall survival (OS) in primary advanced-stage disease, specifically when administered during interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT). Conversely, its role in primary debulking and recurrent settings remains controversial. While some trials show benefits, others, including the HORSE trial, found no significant difference in OS. Furthermore, HIPEC is associated with increased morbidity, including longer operative times and a higher incidence of grade 3-5 adverse events. Consequently, current guidelines primarily recommend HIPEC as an option for stage III patients during IDS. While a promising advance, further research is required to standardize protocols and optimize patient selection.