PURPOSE: TO REVIEW THE TWO MAIN APPROACHES OF INTRAPERITONEAL (IP) CHEMOTHERAPY 
DELIVERY IN OVARIAN CANCER: postoperative adjuvant IP chemotherapy after 
cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal 
chemotherapy (HIPEC).
METHODS: A literature search was conducted to identify studies that employed 
postoperative adjuvant IP chemotherapy after CRS or combined CRS and 
intraoperative HIPEC in patients with ovarian cancer. Data of interest included 
chemotherapy protocol, morbidity and mortality, and survival data.
RESULTS: Three large randomized controlled trials comprising 707 patients with 
advanced ovarian cancer who received postoperative adjuvant IP chemotherapy were 
reviewed. Morbidity rate ranged from 56% to 94% in IP chemotherapy, and 
mortality rate ranged from 1% to 2%. Median disease-free survival ranged from 24 
to 28 months, and overall survival ranged from 49 to 66 months. Planned 
chemotherapy completion rates ranged from 42% to 71%. Twenty-four nonrandomized 
studies that reported HIPEC comprised 1167 patients with both advanced and 
recurrent ovarian cancer. In patients with advanced ovarian cancer, mortality 
ranged from 0% to 5%, minor morbidity ranged from 16% to 90%, and major 
morbidity ranged from 0% to 40%. Median disease-free survival ranged from 13 to 
56 months, and overall survival ranged from 14 to 64 months. Survival at 5 years 
ranged from 35% to 70%. In patients with recurrent ovarian cancer, the mortality 
rate ranged from 0% to 10%, minor morbidity ranged from 7% to 90%, and major 
morbidity ranged from 0% to 49%. Median disease-free survival ranged from 13 to 
24 months and overall survival from 23 to 49 months. Survival at 5 years ranged 
from 12% to 54%.
CONCLUSION: There is level-one evidence suggesting the benefit of postoperative 
adjuvant intraperitoneal chemotherapy for patients with advanced ovarian cancer 
after cytoreductive surgery, albeit catheter-related complications resulted 
after treatment discontinuation. Studies report the use of HIPEC predominantly 
in the setting of recurrent disease and have demonstrated encouraging results, 
which merits further investigation in future clinical trials.