Introduction/Background*Based on the results of the randomized controlled OVHIPEC-1 trial, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with cisplatin has been incorporated in Dutch evidence based guidelines and is considered routine treatment in patients with stage III epithelial ovarian cancer following complete or optimal interval cytoreductive surgery (CRS). Differences in patient selection criteria, technical aspects and perioperative management exist between the ten Dutch centers that perform HIPEC for ovarian cancer. As part of an implementation process, we aim to standardize these important aspects using a consensus-based Delphi approach.
Methodology This consensus study comprised a two-phase modified Delphi approach involving 40 experts with experience in performing the HIPEC procedure for ovarian cancer (gynecological oncologists, medical oncologists, oncological surgeons and anesthesiologists). Key aspects of HIPEC were identified in panel discussions. Next, the expert panel completed a survey consisting of various statements and questions about these aspects. During a subsequent consensus meeting, survey outcomes were discussed considering the available scientific evidence. Consensus was defined as ≥75% agreement on a statement or question. Statements with <75% agreement were adjusted based on feedback from the panel members. Level of agreement with the revised items is currently determined in a second survey.
Result(s)*In the first round, the response rate was 98% and consensus was seen for 45% of statements and questions. Highest agreement was present for selected statements on CRS and postoperative care. For those statements consensus was reached, agreement varied from 78-100% (statements on CRS) and 78-95% (statements on postoperative care). Items on patient selection, setting the indication, preoperative workup, and technical aspects of HIPEC required more panel discussion and revision. Results of the second round will be available by July 2021.
Conclusion*A Dutch expert panel reached substantial agreement on a number of statements regarding HIPEC for ovarian cancer. Lack of consensus was generally associated with absence of robust scientific evidence. The results of this consensus study can help to align treatment protocols and minimize practice variation. These efforts will ensure optimal and safe introduction of HIPEC in the Netherlands, result in a safe treatment for all eligible patients and may guide the research agenda on HIPEC for ovarian cancer.
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