Cytoreductive Surgery (CRS) and HIPEC for Advanced Ovarian Cancer with Peritoneal Metastases: Italian PSM Oncoteam Evidence and Study Purposes

Simple Summary Ovarian cancer is still the most lethal gynecologic malignancy with a median 5-year survival of less than 50%. Most cases are diagnosed at the advanced stages and only limited improvements in overall survival are achieved by standard treatments. Despite the paucity of randomized clinical trials, combined cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) show encouraging survival outcomes in primary ovarian cancer with peritoneal metastases. It gives rise to the definite need to redefine not only the best treatment option, but also the optimal treatment sequence based on the primary tumor and the extent of disease. Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively.