Surgery Together with Heated Chemotherapy (Hyperthermic Chemotherapy) in Recurrent Ovarian Cancer

In our previous article recurrent (relapsed) ovarian cancerwas discussed, explaining that surgery can provide significant benefit in selected patients. Although applying heated chemotherapy immediately after surgery is one treatment option, it is not a preferred option with proven benefit. Caution is needed regarding its use in routine practice before results of the large randomized study currently underway are announced. However, heated chemotherapy administered into the abdomen has always attracted patients and physicians by its very nature. We therefore wanted to explain this treatment method, which attracts so much interest and curiosity, and its evidence-based areas of use.

The scientific name for heated chemotherapy administered into the abdomen is Hyperthermic Intra-Peritoneal Chemotherapy (HIPEC). In studies, applying this treatment option particularly in patients with mucinous colon cancer with limited spread inside the abdomen made a significant contribution to treatment success. Building on this success, it has been used over the years particularly in patients with high-risk ovarian cancer and has been shown to benefit patients in whom it was used after initial surgery. However, because of the difficulty of the method and the high rate of side effects following the procedure, it has not become an unequivocally recommended treatment method in treatment guidelines.

How is HIPEC administered?

After all tumors in the abdomen have been removed surgically as far as possible, a chemotherapy drug heated in infusion fluid to up to 42 degrees is circulated through the abdominal cavity using special devices for 2 hours while the patient remains asleep under general anesthesia. Cancer cells are known to be more sensitive to heat (hyperthermia) than normal cells. Administering heated chemotherapy inside the abdomen allows the drug to penetrate the tumor both better and at a much higher concentration. However, the difficulty of administering the method, its cost and treatment-related side effects overshadow the potential benefit.

In conclusion, although HIPEC, known as heated chemotherapy administered into the abdomen in ovarian cancer, appears to be a treatment method that may be chosen after initial surgery in selected patients and by experienced teams, it has still not taken its place in treatment guidelines. Numerous published case series and retrospective analysis studies claim it is beneficial in patients with recurrence. A well-designed comparative study in patients with recurrence is ongoing, and its results should be awaited before moving to routine clinical practice.