Prolonged Exposition with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) May Provide Survival Benefit after Cytoreductive Surgery (CRS) in Advanced Primary Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

SIMPLE SUMMARY: The mainstay of therapy for primary advanced ovarian, fallopian tube, and primary peritoneal carcinoma is cytoreductive surgery (CRS) and platinum-containing chemotherapy. Since the primary and recurrent disease is mainly confined to the peritoneal cavity, intraperitoneal chemotherapy with or without hyperthermia has been evolved in order to improve survival. However, the studies to date are mainly retrospective, nonrandomized, and heterogeneous in terms of patient selection. There are currently only a limited number of reliable data on the role of hyperthermic intraperitoneal chemotherapy (HIPEC), its ideal timing of application, and duration. The aim of this study was to report our single-center experience with CRS + HIPEC involving patients with primary FIGO stage ≥ III B epithelial carcinoma. Hereby, multimodal therapy was feasible with acceptable morbidity and mortality, with no difference in overall survival between interval and upfront surgery. However, prolongation of HIPEC was shown to provide survival benefits regardless of previous administration of chemotherapy. ABSTRACT: Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, 37, 62, and 25 patients were enrolled into the HIPEC with/without neoadjuvant chemotherapy (upfront vs. interval) and into the 60 min and 90 min long HIPEC groups, respectively. Better overall survival (OS) was observed in the 90 min HIPEC group (p = 0.0330), compared to the 60 min HIPEC group. Neither OS (p = 0. 2410), disease-specific (p = 0. 3670), nor recurrence-free survival (p = 0.8240) differed between upfront and interval HIPEC. Higher peritoneal carcinomatosis index (PCI) values were associated with worse disease-specific survival (p = 0.0724). Age (p = 0.0416), body mass index (p = 0.0044), PCI (p < 0.0001), the type (p = 0.0016) and duration (p = 0.0012) of HIPEC, and increased perioperative morbidity (p < 0.0041) had the greatest impact on OS. Conclusions: Increasing data support the value of HIPEC in the treatment of advanced ovarian cancer. Ongoing prospective studies will definitively clarify the role and timing of this additional therapeutic approach.