Systemic Chemotherapy and Hipec in Gynecologic Malignancies
Özet
Systemic chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) constitute key therapeutic modalities in gynecologic malignancies, particularly in tumors with a high propensity for peritoneal dissemination. Chemotherapy exerts its antineoplastic effect through multilayered cellular mechanisms, including disruption of DNA synthesis, inhibition of microtubule dynamics, and activation of apoptotic pathways, thereby serving broad indications in primary, adjuvant, neoadjuvant, and palliative settings. Platinum–taxane based regimens remain the cornerstone of first-line therapy in epithelial ovarian cancer and high risk endometrial carcinoma, while integration of histopathological subtype and molecular classification enables refined, individualized treatment strategies. In the recurrent setting, platinum sensitivity is the principal determinant of therapeutic selection, and targeted therapies are increasingly incorporated alongside chemotherapy to enhance efficacy in appropriately selected patients. HIPEC leverages the pharmacokinetic advantages conferred by the peritoneal–plasma barrier, allowing intraperitoneal administration of chemotherapeutic agents under hyperthermic conditions to potentiate cytotoxicity. In FIGO stage III epithelial ovarian cancer, cisplatin-based HIPEC administered at the time of optimal interval cytoreductive surgery following neoadjuvant chemotherapy represents the only phase III evidence-supported indication, demonstrating significant improvements in recurrence-free and overall survival. In contrast, the role of HIPEC in endometrial carcinoma, uterine sarcomas, and other gynecologic malignancies remains limited to highly selected cases of peritoneal carcinomatosis managed within experienced centers. Collectively, these modalities form essential components of multidisciplinary management in gynecologic oncology, guided by tumor biology, surgical feasibility, and pharmacokinetic considerations to optimize clinical outcomes.
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