HIPEC for Advanced Ovarian Cancer: Why It May Be the Right Treatment for the Right Patient
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Somashekhar, S.P. HIPEC in Advanced Ovarian Cancer: From Controversy to Contextual Standard of Care. Indian J Gynecol Oncolog 24, 52 (2026). https://doi.org/10.1007/s40944-026-01122-4
Key Takeaway
A new editorial reviews the growing evidence supporting hyperthermic intraperitoneal chemotherapy (HIPEC) for carefully selected patients with advanced ovarian cancer. While HIPEC isn't appropriate for everyone, the author argues that it has evolved from a controversial treatment to an important part of care for the right patient, at the right time, in experienced centers.
Why This Matters
Advanced ovarian cancer often spreads throughout the lining of the abdomen (the peritoneum), making it a peritoneal surface cancer rather than simply a disease of one organ.
Even when surgeons successfully remove all visible tumors (called complete cytoreduction or CC-0), tiny cancer cells can remain behind. These microscopic cells may eventually grow and lead to recurrence.
HIPEC is designed to treat these remaining cancer cells by circulating heated chemotherapy throughout the abdominal cavity immediately after surgery. The heat helps the chemotherapy penetrate tissues more effectively while limiting exposure to the rest of the body.
What the Evidence Shows
The author highlights the landmark OVHIPEC-1 clinical trial, which changed how many experts view HIPEC.
Researchers found that women with stage III epithelial ovarian cancer who received HIPEC during interval cytoreductive surgery after neoadjuvant chemotherapy experienced:
Longer overall survival
No significant increase in serious postoperative complications
No reduction in long-term quality of life compared with surgery alone
These findings suggest that adding HIPEC can improve outcomes without making recovery substantially more difficult.
HIPEC Is Not for Everyone
One of the most important messages in this editorial is that patient selection matters.
Current evidence most strongly supports HIPEC for patients who:
Have Stage III epithelial ovarian cancer
Receive chemotherapy before surgery (neoadjuvant chemotherapy)
Undergo interval cytoreductive surgery
Can achieve complete removal of all visible disease (CC-0)
The author emphasizes that HIPEC should not be used routinely for every ovarian cancer patient. Instead, treatment decisions should be individualized and made by an experienced multidisciplinary team.
Why Experience Matters
Successful HIPEC treatment depends on much more than simply delivering heated chemotherapy.
The editorial notes that outcomes are best at high-volume centers with experienced surgeons and multidisciplinary teams that specialize in cytoreductive surgery and HIPEC. Registry studies from these centers have shown outcomes similar to those seen in clinical trials, reinforcing the importance of expertise and careful patient selection.
Looking Ahead
As ovarian cancer treatment continues to evolve with newer therapies such as PARP inhibitors and other targeted treatments, researchers are studying how HIPEC fits into today's treatment landscape.
Ongoing studies, including OVHIPEC-2, aim to better define which patients benefit most and how HIPEC should be combined with modern systemic therapies. Rather than replacing chemotherapy or targeted therapies, HIPEC may work alongside them by treating microscopic cancer cells within the abdomen that surgery and intravenous chemotherapy cannot fully eliminate.
The Bottom Line
This editorial concludes that the question is not whether every patient with ovarian cancer should receive HIPEC. Instead, the focus should be on ensuring that patients who are most likely to benefit are evaluated at experienced centers where all appropriate treatment options—including CRS and HIPEC—can be considered.
For carefully selected patients with advanced ovarian cancer, HIPEC may provide a meaningful survival benefit without compromising quality of life, making it an important part of multidisciplinary cancer care.
