The role of hyperthermic intraperitoneal chemotherapy (HIPEC) as a standard treatment procedure in the field of gynecologic oncology is controversial. Although widely discussed and studied as a subsidiary method of interval cytoreductive surgery, HIPEC is still being debated for the management of advanced and recurrent epithelial ovarian cancer (EOC). The results from many large trials support the safety and efficacy of HIPEC in well-selected EOC patients, where it has been shown to increase overall survival. Interestingly, recent findings support the effectiveness of HIPEC even when performed at the time of primary debulking surgery for stage III EOC patients in whom complete cytoreduction is anticipated. The results from large ongoing trials will soon be available. There are also promising results for HIPEC combined with adjuvant chemotherapy with platinum compounds in the management of advanced stage peritoneal-disseminated endometrial and cervical cancer. In patients with abdominally confined disease, HIPEC has been considered for peritoneal carcinomatosis of non-gynecological origin. Many authors have published evidence that supports explorative surgery followed by cytoreduction and HIPEC. Initially this was for cases of pseudomyxoma peritonei and malignant peritoneal mesothelioma, but was later followed by cases of gastric, colorectal and even breast cancer patients with pelvic peritoneal metastases.
Nevertheless, more prospective multi-center randomized studies are needed in order to draw conclusions about the safety of HIPEC and to determine which patients could benefit from its implementation. Further studies are also required to obtain robust data on the surgical procedures, the type and dose of chemotherapeutic regimens, and the temperature and duration of the hyperthermic arm needed to achieve optimal oncological outcomes. This information should help to support the recommendation of HIPEC in the gynecological cancer community.
The aim of this special issue is therefore to publish novel studies on the potential role of HIPEC in different gynecological cancers, through exploration of the indications, technique, and future challenges. We welcome authors to submit case reports, case series, retrospective studies, randomized trials and reviews in this field.
Prof. Dr. Christos Iavazzo
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