Literature Review I Important Evidence for Ovarian Cancer Treatment: Can HIPEC Combined with Surgery Bring Longer Survival Benefits?

Advanced ovarian cancer, especially in patients with extensive intraperitoneal dissemination, has long been a challenge in gynecologic oncology. Because ovarian cancer tends to implant and recur on the peritoneal surface, systemic therapy and surgery alone are sometimes insufficient to adequately control microscopic residual disease within the peritoneal cavity.

Therefore, how to further reduce the risk of intraperitoneal recurrence and prolong patient survival after cytoreductive surgery remains a key clinical priority.

The New England Journal of Medicine (NEJM) has published important research and subsequent academic correspondence on the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in stage III epithelial ovarian cancer. The evidence suggests that for select patients undergoing interval cytoreductive surgery after neoadjuvant chemotherapy, the addition of cisplatinbased HIPEC to surgery can provide a superior survival benefit, with an overall manageable safety profile.

I. Why Does HIPEC Attract Attention?

Recurrence of ovarian cancer is often closely linked to residual intraperitoneal lesions. Even after surgery has removed all visible tumor deposits to the greatest possible extent, microscopic residual disease may still remain on the peritoneal surface, pelvic cavity, omentum, or mesentery—areas that are difficult to identify with the naked eye.

The core rationale behind HIPEC is to circulate heated chemotherapeutic agents within the peritoneal cavity immediately after cytoreductive surgery, allowing the drugs to act directly on potential residual lesions in the abdomen.

This approach has two distinctive features:

First, it achieves a higher local drug concentration, which is advantageous for directly targeting intraperitoneal disease. Second, the hyperthermic effect may act synergistically with the chemotherapeutic agents, enhancing the cytotoxic effect on tumor cells.

For ovarian cancer, which is characterized by intraperitoneal dissemination, HIPEC thus represents a regional therapeutic strategy worthy of attention.

II. Key Findings: Significant Prolongation of Overall Survival

The original NEJM study demonstrated that among patients with stage III epithelial ovarian cancer who underwent interval cytoreductive surgery after neoadjuvant chemotherapy, those receiving cisplatin-based HIPEC achieved longer overall survival compared to the surgery-alone group.

In the subsequent authors’ reply, it was further noted that the median overall survival was 33.9 months in the surgeryalone group, whereas it increased to 45.7 months in the surgeryplusHIPEC group—meaning that, in this study population, the addition of HIPEC extended median overall survival by approximately 11.8 months.

These findings suggest that, for selected patients with stage III epithelial ovarian cancer who are eligible for interval cytoreductive surgery, HIPEC may further improve longterm survival outcomes beyond surgery alone.

III. Improved Recurrence Pattern: Reduced Peritoneal Recurrence Rate

In addition to the overall survival benefit, the impact of HIPEC on recurrence patterns also warrants attention.

The NEJM correspondence in the appendix cites a propensity scorematched retrospective casecontrol study. This study found that the peritoneal recurrence rate was significantly lower in the surgeryplusHIPEC group compared to the surgeryalone group: 43% in the surgeryalone group versus 14% in the surgeryplusHIPEC group, with a statistically significant difference.[2][3]

This finding suggests that the role of HIPEC may extend beyond prolonging survival time and may also be associated with altering the pattern of intraperitoneal recurrence. For ovarian cancer, which is prone to peritoneal dissemination and abdominal recurrence, this has important clinical implications.

Advanced ovarian cancer, especially in patients with extensive intraperitoneal dissemination, has long been a challenge in gynecologic oncology. Because ovarian cancer tends to implant and recur on the peritoneal surface, systemic therapy and surgery alone are sometimes insufficient to adequately control microscopic residual disease within the peritoneal cavity.

Therefore, how to further reduce the risk of intraperitoneal recurrence and prolong patient survival after cytoreductive surgery remains a key clinical priority.

The New England Journal of Medicine (NEJM) has published important research and subsequent academic correspondence on the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in stage III epithelial ovarian cancer. The evidence suggests that for select patients undergoing interval cytoreductive surgery after neoadjuvant chemotherapy, the addition of cisplatinbased HIPEC to surgery can provide a superior survival benefit, with an overall manageable safety profile.

IV. Why Does HIPEC Attract Attention?

Recurrence of ovarian cancer is often closely linked to residual intraperitoneal lesions. Even after surgery has removed all visible tumor deposits to the greatest possible extent, microscopic residual disease may still remain on the peritoneal surface, pelvic cavity, omentum, or mesentery—areas that are difficult to identify with the naked eye.

The core rationale behind HIPEC is to circulate heated chemotherapeutic agents within the peritoneal cavity immediately after cytoreductive surgery, allowing the drugs to act directly on potential residual lesions in the abdomen.

This approach has two distinctive features:

First, it achieves a higher local drug concentration, which is advantageous for directly targeting intraperitoneal disease. Second, the hyperthermic effect may act synergistically with the chemotherapeutic agents, enhancing the cytotoxic effect on tumor cells.

For ovarian cancer, which is characterized by intraperitoneal dissemination, HIPEC thus represents a regional therapeutic strategy worthy of attention.

V. Key Findings: Significant Prolongation of Overall Survival

The original NEJM study demonstrated that among patients with stage III epithelial ovarian cancer who underwent interval cytoreductive surgery after neoadjuvant chemotherapy, those receiving cisplatin-based HIPEC achieved longer overall survival compared to the surgery-alone group.

In the subsequent authors’ reply, it was further noted that the median overall survival was 33.9 months in the surgery-alone group, whereas it increased to 45.7 months in the surgery-plus-HIPEC group—meaning that, in this study population, the addition of HIPEC extended median overall survival by approximately 11.8 months.

These findings suggest that, for selected patients with stage III epithelial ovarian cancer who are eligible for interval cytoreductive surgery, HIPEC may further improve long-term survival outcomes beyond surgery alone.

VI. Improved Recurrence Pattern: Reduced Peritoneal Recurrence Rate

In addition to the overall survival benefit, the impact of HIPEC on recurrence patterns also warrants attention.

The NEJM correspondence in the appendix cites a propensity score-matched retrospective case-control study. This study found that the peritoneal recurrence rate was significantly lower in the surgery-plus-HIPEC group compared to the surgery-alone group: 43% in the surgery-alone group versus 14% in the surgery-plus-HIPEC group, with a statistically significant difference.[2][3]

This finding suggests that the role of HIPEC may extend beyond prolonging survival time and may also be associated with altering the pattern of intraperitoneal recurrence. For ovarian cancer, which is prone to peritoneal dissemination and abdominal recurrence, this has important clinical implications.