Indications for hyperthermic intraperitoneal chemotherapy with cytoreductive surgery: a clinical practice guideline

Objective The purpose of this present review was to provide evidence-based guidance regarding the provision of CRS with HIPEC in the treatment of peritoneal cancers. Methods The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care, together with the Surgical Oncology Program, through a systematic review of relevant literature, patient and caregiver-specific consultation and internal and external reviews. Results Recommendation 1a: For patients with newly diagnosed, primary stage III epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, HIPEC should be considered for those with at least stable disease following neoadjuvant chemotherapy at the time of interval CRS if complete or optimal cytoreduction is achieved. Recommendation 1b: There is insufficient evidence to recommend the addition of HIPEC when primary CRS is performed for patients with newly diagnosed, primary advanced epithelial ovarian, fallopian tube, or primary peritoneal carcinoma outside of a clinical trial. Recommendation 2: There is insufficient evidence to recommend HIPEC with CRS in patients with recurrent ovarian cancer outside the context of a clinical trial. Recommendation 3: There is insufficient evidence to recommend HIPEC with CRS in patients with peritoneal colorectal carcinomatosis outside of a clinical trial. Recommendation 4: There is insufficient evidence to recommend HIPEC with CRS for the prevention of peritoneal carcinomatosis in CRC outside of a clinical trial; however HIPEC using oxaliplatin is not recommended. Recommendation 5: There is insufficient evidence to recommend HIPEC with CRS for the treatment of gastric peritoneal carcinomatosis outside of a clinical trial. Recommendation 6: There is insufficient evidence to recommend HIPEC with CRS for the prevention of gastric peritoneal carcinomatosis outside of a clinical trial. Recommendation 7: There is insufficient evidence to recommend HIPEC with CRS in patients with malignant peritoneal mesothelioma as a standard of care; however, patients should be referred to HIPEC specialty centres for assessment for treatment as part of an ongoing research protocol. Recommendation 8: There is insufficient evidence to recommend HIPEC with CRS in patients with disseminated mucinous neoplasm in the appendix as a standard of care; however, patients should be referred to HIPEC specialty centres for assessment for treatment as part of an ongoing research protocol.