The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to cytoreductive surgery prolonged survival among patients with stage III epithelial ovarian cancer, according to the results of a cohort study published in JAMA Network Open.1

The current standard of care for patients with stage III ovarian cancer is primary cytoreductive surgery (PCS) plus platinum/paclitaxel-based chemotherapy. Intraperitoneal chemotherapy may have advantages over intravenous delivery, because “the cancer cells tend to stay within the peritoneal cavity, attaching to organ surfaces and only invading superficial layers,” Raanan Alter, MD, and colleagues wrote in an invited commentary.2

Hyperthermia could increase the accumulation of chemotherapy in cancer cells. Therefore, the purpose of this study was to evaluate the outcomes associated with hyperthermic intraperitoneal chemotherapy (HIPEC) in a larger cohort of patients with epithelial ovarian cancer.1

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The multicenter, retrospective, cohort study evaluated data from 584 patients, including 72.8% who underwent HIPEC plus PCS and 27.2% who underwent PCS alone. The primary endpoint was median survival time and 3-year overall survival (OS).

At baseline, the median patient age was 55 and the majority of patients had tumors with high-grade, serous histology.

The addition of HIPEC was associated with significantly longer survival time during the median follow-up time of 42.2 months. The median survival was 49.8 months with HIPEC and PCS compared with 34 months with PCS alone (hazard ratio [HR], 0.63; 95% CI, 0.49-0.82; P <.001). The OS at 3 years was 60.3% with HIPEC and PCS compared with 49.5% with PCS alone (HR, 0.64; 95% CI, 0.50-0.82; P <.001). This benefit was highest among patients who had a complete, rather than incomplete, PCS.

Grade 3 to 4 adverse events (AEs) that occurred more frequently in the HIPEC group included electrolyte disturbances in 28.1% of patients compared with 11.5% of patients who underwent PCS alone (P <.001). Time to first flatus and mean hospital stay were longer in the HIPEC group.

The authors wrote that “the PCS with HIPEC treatment approach was associated with better long-term survival and was not associated with postoperative severe morbidity or mortality.” They added that “when complete PCS is possible, this approach can be a valuable therapy among patients with stage III epithelial ovarian cancer.”

In an invited commentary, Dr Alter and colleagues noted that the authors of the study used an “unusual method of multiday HIPEC with lower-dose cisplatin … and is difficult to generalize to other institutions that use single-time HIPEC during cytoreductive surgery.”2

Nonetheless, the commentary suggests that based on these and other data, “one should discuss the use of HIPEC postoperatively with patients with stage III low-volume disease who are thought to likely experience optimal (RO) cytoreduction.”2


  1. Lei Z, Wang Y, Wang J, et al. Evaluation of cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for stage III epithelial ovarian cancer. JAMA Netw Open. 2020;3(8):e2013940. doi:10.1001/jamanetworkopen.2020.13940
  2. Alter R, Turaga K, Lengyel E. Are we ready for hyperthermic intraperitoneal chemotherapy in the upfront treatment of ovarian cancer? JAMA Netw Open. 2020;3(8):e2013940. doi:10.1001/jamanetworkopen.2020.13940