In women with metastases of ovarian cancer restricted to the
abdominal cavity (stage III), it appears that hyperthermic
intraperitoneal chemotherapy, HIPEC, improves the survival rate by
10%. Moreover, the treatment has almost no additional side effects.
This research, led by the Netherlands Cancer Institute, was carried
out in collaboration with five other hospitals and will be
published in the prestigious New England Journal on January 18,
2018. A total of 245 patients participated in the study.
Ovarian cancer is the gynecological malignancy with the highest
mortality worldwide. In the Netherlands, approximately 1300 women
receive a diagnosis of ovarian cancer annually. In about 75% of
cases, the disease has already metastasized in the abdomen when
diagnosed. The standard treatment, in this case, consists of a
comprehensive operation in combination with chemotherapy. There are
two treatment strategies, the patient either starts with an
operation followed by 6 courses of chemotherapy [primary debulking]
or is given three chemotherapy courses before and three after the
operation [interval debulking]. With this treatment, about a third
of the patients are still alive after five years.
Over the last ten years, The Netherlands Cancer Institute has,
in collaboration with five other hospitals (AMC, St. Antonius
Hospital Nieuwegein/UMC Utrecht, UMC Groningen, Catharina Hospital
Eindhoven and Radboud UMC), studied whether an abdominal lavage
with heated chemotherapy in combination with interval debulking
improves the chances of a cure. The study shows that, after five
years, women who received a HIPEC treatment had 10% more chance of
survival than women who did not undergo the HIPEC treatment. There
was also no difference seen in the side effects or complications
between the 2 groups, and the HIPEC was well tolerated.
Between 2007 and 2016, half of the number of women with stage
III ovarian carcinoma who were treated with an interval debulking
received the new HIPEC treatment. Prior to the operation, all of
the women were given three rounds of chemotherapy. Women for whom
the gynecologist was able to remove virtually all of the tumors
during surgery were eligible for the study. A drawing of lots
determined who got the abdominal lavage and who did not. The
abdominal lavage was applied at the end of surgery. After surgery,
all of the women were given three more rounds of chemotherapy.
What does this mean in practice?
The results of this study are now being published in the New
England Journal of Medicine. The results of this study will be
discussed by the guidelines committee for gynecological oncology.
This treatment is expected to become part of the standard treatment
in the Netherlands as soon as it is accepted as insured care and
there is an agreement on the financial compensation for this
Reuters: Heated abdominal chemo bath improves
ovarian cancer survival