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. 2022 May 9:12:809773.
doi: 10.3389/fonc.2022.809773. eCollection 2022.

Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in Ovarian Cancer: An Umbrella Review of Meta-Analyses

Amine Souadka  1 , Hajar Essangri  1 , Mohammed Anass Majbar  1 , Amine Benkabbou  1 , Saber Boutayeb  2 , Benoit You  3 , Olivier Glehen  4 , Raouf Mohsine  1 , Naoual Bakrin  4
Affiliations

Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery in Ovarian Cancer: An Umbrella Review of Meta-Analyses

Amine Souadka et al. Front Oncol. .

Abstract

Background: The utility of heated intraperitoneal chemotherapy (HIPEC) in the management of epithelial ovarian cancer (EOC) has been assessed in several randomised clinical trials and meta-analyses, and it is still a subject of controversy. Therefore, we performed an umbrella review of existing meta-analyses to summarise the outcomes of HIPEC and cytoreductive surgery (CRS) association in ovarian cancer.

Methods: We examined the MEDLINE, Cochrane Library, Scopus, Prospero, Web of Science and Science Direct from inception to May 30, 2020, for meta-analyses of randomised controlled trials and observational studies. Analyses of overall survival, disease free survival and progression survival were performed separately for primary and recurrent ovarian cancers.

Results: We identified 6 meta-analyses investigating the association of HIPEC with CRS in the management of ovarian cancer. Three year overall survival was significantly improved by the association of CRS and HIPEC for primary (HR: 0.66, 95%CI:0.56-0.78) and recurrent ovarian cancers (HR:0.50, 95%CI:0.38-0.64). This benefit was also demonstrated on disease-free survival for primary (HR: 0.54, 95%CI:0.48-0.61) and recurrent ovarian cancer (HR: 0.60, 95%CI:0.46-0.78). The pooled hazard ratios confirmed the advantage of HIPEC and CRS association with respect to CRS alone on progression free survival for primary and recurrent ovarian cancer respectively with HR: 0.50, 95%CI: 0.43-0.58 and HR: 0.59, 95%CI: 0.41-0.85.

Conclusion: While waiting for the results of the current prospective studies, the present umbrella study suggests that HIPEC performed at the end of CRS may be a complementary effective asset for ovarian cancer patient management.

Keywords: HIPEC; cytoreductive surgery and HIPEC; epithelial ovarian cancer; meta-analysis; peritoneal carcinomatosis (PC); umbrella review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Search flowchart. *A list of excluded studies is provided in Appendix 1 (List of excluded articles Appendix) .
Figure 2
Figure 2
HIPEC + CRS versus CRS overall survival forest plots (A) primary ovarian cancer (B) recurrent ovarian cancer.
Figure 3
Figure 3
HIPEC + CRS versus CRS disease free survival forest plots (A) primary ovarian cancer (B) recurrent ovarian cancer.
Figure 4
Figure 4
HIPEC + CRS versus CRS progression free survival forest plots (A) primary ovarian cancer (B) recurrent ovarian cancer.
See this image and copyright information in PMC

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