The standard treatment for advanced ovarian cancer consists in complete 
cytoreductive surgery (CRS) and intravenous combination chemotherapy with a 
platinum compound and a taxane. Although response rates to initial therapy are 
high, many patients will recur and die of peritoneal carcinomatosis. The 
addition of Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) to the standard 
therapy aims at increasing survival by reducing peritoneal recurrence. This 
review describes the survival results of HIPEC at the different time-points of 
the treatment of ovarian cancer: at upfront CRS, at interval CRS, at 
consolidation CRS after complete response to initial therapy, at secondary CRS 
after incomplete response, at salvage CRS for recurrence and as palliative 
treatment without CRS for unresectable ovarian cancer with chemotherapy 
resistant ascites. The available evidence suggests that a potential survival 
benefit of adding HIPEC may be largest in the settings of secondary CRS for 
stage III ovarian cancer and salvage CRS for recurrent ovarian cancer, two 
time-points representing failure of initial standard therapy. There is much less 
evidence for a potential benefit of HIPEC for less advanced stages (I-II) and 
for earlier time-points in the treatment of ovarian cancer (upfront, interval 
and consolidation). Postoperative mortality is not higher after CRS and HIPEC 
(0.7%) than after CRS only (1.4%). Four randomised trials are ongoing and their 
results are eagerly awaited. Palliative HIPEC without CRS might be used more in 
patients with incapacitating ascites due to recurrent ovarian cancer which has 
become resistant to systemic chemotherapy.