Ovarian cancer is the commonest gynaecological cancer and the fifth leading cause of cancer death in women worldwide. The majority of patients with ovarian cancer present at an advanced stage, and up to 70% of those treated with a curative approach eventually recur and succumb to their disease. This article examines the management of ovarian cancer over the years and the role of intraperitoneal chemotherapy in the treatment algorithm.
The surgical paradigm for ovarian cancer has changed and the goal is optimal cytoreduction with no residual disease. Intraperitoneal chemotherapy has been found to be superior to intravenous treatment alone, and the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has produced encouraging results with improved disease-free and overall survivals at acceptable morbidity and mortality rates.
The most important prognostic factor for ovarian cancer survival is the ability to achieve optimal cytoreduction with no residual disease. CRS and HIPEC should be considered as an option for the management of advanced ovarian cancer and further trials are required to determine its role in both the primary and recurrent settings.
aCentre for Peritoneal and Pelvic Disease
bDepartment of Surgical Oncology, National Cancer Centre (S)
cDepartment of General Surgery, Singapore General Hospital
dDepartment of Gynaecologic Oncology, KKWCH
eDuke-NUS Graduate Medical School
fYong Loo Lin School of Medicine
Correspondence to Melissa C.C. Teo, MBBS, FRCS, FAMS, MPH, Department of Surgical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore. Tel: +65 6436 8283/8294; e-mail: Melissa.Teo.C.C@nccs.com.sg