Multisocietal Consensus on the Use of Cytoreductive Surgery and HIPEC for the Treatment of Epithelial Ovarian Cancer: A GRADE Approach for Evidence Evaluation and Recommendation
Bibliographic record
Abstract
INTRODUCTION: The locoregional treatment of high grade serous ovarian cancer (HGSOC) comprises of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Recent evidence form randomized trials, has led to controversy related to the use of HIPEC in addition to interval CRS (iCRS) and the role of secondary CRS (sCRS) in patients with the first platinum-sensitive recurrence from high-grade serous ovarian cancer (HGSOC). This multi-society consensus, coordinated by the Peritoneal Surface Oncology Group International (PSOGI) with inputs from ISSPP, SSO, ESSO, and IGCS, evaluated the role of these interventions using the GRADE ADOLOPMENT methodology. PATIENTS AND METHODS: An international expert panel reviewed evidence for the use of HIPEC in addition to iCRS in stage 3 high grade serous ovarian cancer (HGSOC) and the role of sCRS for patients with platinum-sensitive recurrent HGSOC. A systematic review assessed randomized controlled trials (RCTs) for recurrence-free survival (RFS), overall survival (OS), safety, and quality of life (QoL). Recommendations were formulated using the GRADE Evidence-to-Decision framework. RESULTS: HIPEC in addition to iCRS was strongly recommended based on the results of the OVHIPEC-1 trial, which showed significant benefit in RFS (3.5 months) and OS (12 months) without increasing the grade 3-4 morbidity. For the first platinum-sensitive recurrence, a conditional recommendation was made either for sCRS with systemic therapy or systemic therapy alone, reflecting variability in trial outcomes due to heterogeneity in the patient population in the trials and lack of surgical standardization. CONCLUSION: This consensus highlights the benefits of HIPEC in addition of iCRS and key factors that limit its wide-spread use. It underlines the need for individualized decision-making while selecting patients for sCRS. Future research integrating advanced systemic therapies is essential to refine these recommendations and provide equitable access to these complex locoregional treatments.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.163 | 0.287 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.012 | 0.023 |
| Bibliometrics | 0.023 | 0.016 |
| Science and technology studies | 0.005 | 0.005 |
| Scholarly communication | 0.011 | 0.006 |
| Open science | 0.015 | 0.015 |
| Research integrity | 0.016 | 0.013 |
| Insufficient payload (model declined to judge) | 0.006 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".