What question did this study set out to answer?

To compare overall survival and progression outcomes between patients receiving HIPEC with multimodal treatment versus those without for ovarian cancer.

June 15, 2026Open Access

Efficacy and safety of hyperthermic intraperitoneal chemotherapy in treatment of primary or recurrent ovarian cancer: systematic review and meta-analysis

Key Points

To compare overall survival and progression outcomes between patients receiving HIPEC with multimodal treatment versus those without for ovarian cancer.
Systematic search of databases including Ovid-Medline, Web of Science, and PubMed without date restrictions until February 2025.
Included only randomized controlled trials, two independent reviewers conducted quality assessments and data extraction.
Meta-analysis performed using fixed- and random-effects models to pool hazard ratios and risk ratios.
Meta-analysis of six RCTs with 773 patients found significant improvement in OS for primary ovarian cancer receiving HIPEC (HR = 0.74, 95% CI, 0.60 to 0.92).
No improvement in OS for recurrent settings (HR = 1.08, 95% CI, 0.62 to 1.90).
Postoperative complications and progression-related outcomes showed no significant differences in either setting.

Abstract

Background Epithelial ovarian cancer (EOC) is the leading cause of mortality among gynecologic cancers. The standard treatment approach involves primary debulking surgery (PDS) followed by systemic chemotherapy. Hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an additional therapeutic option used alongside cytoreductive surgery (CRS); however, its efficacy and safety remain controversial. Objective This study aims to compare overall survival (OS) and progression-related outcomes between patients receiving standard multimodal treatment with intraoperative HIPEC and those receiving standard multimodal treatment without HIPEC for primary advanced or recurrent EOC, and to evaluate postoperative complications. Methods A systematic search of Ovid-Medline, Web of Science, and PubMed was conducted without date restrictions through February 2025. Only randomized controlled trials (RCTs) were included. Two reviewers independently performed study quality assessments and data extraction. The protocol was registered in PROSPERO (CRD420251067703). Meta-analysis was conducted using fixed- and random-effects models to pool hazard ratios (HR), risk ratios (RR), and mean differences. Heterogeneity was assessed using the I 2 statistic. Results Six RCTs ( n = 773) with moderate-quality evidence were included; of these, four studies (555 patients) were conducted in primary settings and two (218 patients) in recurrent settings. The meta-analysis showed a significant improvement in OS among patients with primary ovarian cancer receiving HIPEC (HR = 0.74, 95% CI, 0.60 to 0.92), but no improvement in the recurrent setting (HR = 1.08, 95% CI, 0.62 to 1.90). No significant differences were observed in progression-related outcomes or postoperative complications (primary ovarian cancer: HR = 0.71, 95% CI, 0.43 to 1.18; recurrent ovarian cancer: HR = 1.54, 95% CI, 1.00 to 2.37), (RR = 1.08, 95% CI = 0.94 to 1.24, I 2 = 0.0%), respectively. Conclusion HIPEC may benefit selected patients with primary advanced EOC, particularly in trials evaluating its use during interval debulking surgery. However, the limited and heterogeneous RCT evidence warrants cautious interpretation. Systematic review registration CRD420251067703 https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067703

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Cite This Study

Ameer et al. (Thu,) studied this question.

synapsesocial.com/papers/6a2f9621a1cfeec490827a9a https://doi.org/https://doi.org/10.3389/fmed.2026.1820816

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