Article Text
Abstract
Introduction There are insufficient evidence regarding the efficacy of Hyperthermic intraperitoneal chemotherapy (HIPEC) in FIGO stage IV epithelial ovarian cancer (EOC). This study aimed to identify the indications of HIPEC in the management of stage IV EOC.
Methods We conducted a retrospective review of medical records for patients who underwent interval debulking surgery (IDS) followed by HIPEC for stage IV EOC between 2010 and 2023. Clinical characteristics, including survival outcomes and metastatic sites, were analyzed with respect to different stages and treatment approaches.
Results A total of 95 patients were confirmed to have stage IV disease. Fifty-two (54.7%) underwent interval debulking surgery, with 34 (63.9%) in the IDS-only group and 18 (34.6%) in the IDS-HIPEC group. Among these patients, 23 (44.2%) were classified as stage IVa, and 29 (55.8%) as stage IVb. In the survival analysis for the entire cohort, IDS-HIPEC demonstrated superior survival outcomes compared to the IDS-only group (PFS, OS; p = 0.047, 0.025, respectively). However, the survival improvement was mainly observed in patients with stage IVb disease (P-value PFS, OS: IVa, p = 0.274, 0.274; IVb, p = 0.055, p = 0.001). Among the patients with stage IVb in the HIPEC group (n=15), 93% (14/15) underwent complete resection of metastatic lesions, including thoracic lesions (7/7), neck/supraclavicular lesions (3/4), and intra-abdominal lesions (4/4).
Conclusion/Implications Clear evidence supporting the use of additional HIPEC during IDS for FIGO stage IVa disease was not found. However, the addition of HIPEC demonstrated improved survival outcomes in FIGO stage IVb patients who underwent complete primary surgery for metastatic lesions.