Response to: 'Establishing evidence for change in ovarian cancer surgery - Proposing clinical trials of cytoreductive surgery and hyperthermic chemotherapy (HIPEC) in ovarian cancer peritoneal carcinomastis (Chua TC, et al.)'

摘要

I want to thank Dr. Chua and his colleagues for providing details on their two proposed randomized phase 3 trials that critically examine a potential role for HIPEC (hyperthermic intraperitoneal chemotherapy) in the management of newly diagnosed and recurrent ovarian cancer. The designs are appropriately quite straight-forward, ask a single important question, and (if adequate accrual is accomplished) should provide sorely-needed evidenced-based and clinically-relevant data in this arena.One can easily support the "control arm" of these studies based on the rational statement that if a single delivery of HIPEC is to ever be shown to be of benefit in ovarian cancer it is almost certainly be the case that such benefit will be maximized in patients with essentially no gross macroscopic residual cancer when the treatment is delivered. This is due to the well-established knowledge that the depth of direct drug penetration from the surface of normal or malignant tissue is extremely limited [1,2]. If the trials are negative in this optimal disease setting, the approach will certainly be of no utility in individuals with greater volumes of residual cancer within the peritoneal cavity.