An international joint statement about the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer was published in 2016, warning about the uncritical use of HIPEC outside controlled studies. This statement has now been updated after the most recent literature was reviewed by the participating study groups and societies. HIPEC became a treatment option in patients with advanced colon cancer after positive results of a randomized trial comparing surgery and HIPEC versus palliative treatment alone. Although this trial did not compare the added value of HIPEC to surgery alone, HIPEC for the treatment of peritoneal metastases was in the subsequent years generalized to many other cancer types associated with peritoneal carcinomatosis including epithelial ovarian cancer (EOC). In the meantime, new evidence from prospective randomized trials specifically for EOC-patients emerged, with however contradicting results and several quality aspects that made the interpretation of their findings critical. Moreover, three additional trials in colorectal cancer failed to confirm the previously presumed survival benefit through the implementation of HIPEC in peritoneally disseminated colorectal cancers. Based on a still unclear and inconsistent landscape, the authors conclude that HIPEC should remain within the remit of clinical trials for EOC-patients. Available evidence is not yet sufficient to justify its broad endorsement into the routine clinical practice.

2 department of gynaecology and obstetrics University Hospital Bratislava Comenius University Bratislava Slovakia

Centre Léon Bérard Lyon France

Department of Gynaecology National Insitute of Oncology Budapest Hungary

Department of Gynecologic Oncology Medical Faculty Mannheim Heidelberg University Mannheim Germany

Department of Gynecology and Gynecologic Oncology Ev Kliniken Essen Mitte Henricistrasse 92 45136 Essen Germany

Department of Gynecology and Gynecologic Oncology Ev Kliniken Essen Mitte Henricistrasse 92 45136 Essen Germany; Department of Obstetrics and Gynecology Medical University Innsbruck Innsbruck Austria

Department of Gynecology and Obstetrics Ospedale Regionale di Lugano EOC Lugano Switzerland; Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland

Department of Gynecology with Center of Gynecological Oncology Charité University Medicine of Berlin Berlin Germany

Department of Obstetrics and Gynaecology CHU de Liège Liège Belgium

Department of Obstetrics and Gynecology Clinica Universidad de Navarra Madrid Spain

Department of Obstetrics and Gynecology General University Hospital Prague 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Obstetrics and Gynecology Medical University Innsbruck Innsbruck Austria

Department of Obstetrics and Gynecology Paracelsus Medical University Salzburg Salzburg Austria

Department of Obstetrics and Gynecology University Hospital LMU Munich Munich Germany

Departments of Surgery and Cancer Faculty of Medicine Imperial College London London UK

Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology Gynecologic Cancer Unit Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Division of Gynaecological Oncology University Hospitals Leuven Leuven Belgium

Institut Bergonié Bordeaux France

Institut Gustave Roussy Villejuif France

Medical Oncology Department Clínica Univerdad de Navarra Madrid and Program in Solid Tumours CIMA Pamplona Spain

Medical Oncology Department Hospital Universitario La Paz IdiPAZ Madrid Spain

University Hospital Basel Basel Switzerland

University Hospital Geneva Geneva Switzerland

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