Summary
The current standard treatment for ovarian cancer, tubal cancer, and primary peritoneal cancer is maximal cytoreductive surgery followed by chemotherapy. Recent randomized trials of Gynecologic Oncology Group (GOG) revealed the survival gain in intraperitoneal chemotherapy compared to the intravenous chemotherapy after the optimal cytoreduction in ovarian cancer (GOG#104, GOG#114, GOG#172). Experts attributed such survival gain to the earlier cycles of intraperitoneal chemotherapy when adhesion was minimal from extensive cytoreductive procedures. Hyperthermia has an anti-cancer activity itself. Especially, hyperthermia promotes chemotherapy to penetrate deeper into the cancer tissue. Therefore, the combination of intraperitoneal chemotherapy with hyperthermia theoretically could lead to higher response rate and better survival outcomes. \*HIPEC: hyperthermic intraperitoneal chemotherapy There will be an interim analysis when 50% of patients are enrolled. At the interim analysis, a statistical test will be performed. The nominal significance levels will be determined later. The exact nominal significance level will be determined based on the exact number of events at the time of the interim analysis. The Stopping boundaries will be calculated using an O'Brien-Fleming error spending function
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Inclusion Criteria: 1. Disease status Primary ovarian cancer, tubal cancer, and primary peritoneal cancer (Stage III or more) 2. Residual tumor \< 1cm after completion of cytoreductive surgery 3. Age \< 75 year 4. Expected survival \> 3 months 5. Performance status: ECOG 0-1 6. Adequate bone marrow function Hb ≥8 g/dl (After correction in case of iron deficient anemia) WBC ≥ 3,000/mm3, Platelet ≥ 100,000/mm3 7. Adequate renal function Creatinine ≤ 1.5 mg/dl 8. Adequate hepatic function Bilirubin ≤ 1.5 mg/dl and AST and ALT ≤ 80 IU/L 9. Optimal cardiopulmonary function for surgery 10. Voluntary participation after getting written informed consent. Exclusion Criteria: 1. Unresectable extraperitoneal metastasis (brain, bone, lung parenchyme, and supraclavicular lymph node) 2. Suboptimal debulking (residual tumor \> 1cm) 3. Previous History of other malignancies (except excision of skin cancer, thyroid cancer) 4. Serious heart disease or renal failure 5. Serious cardiopulmonary insufficiency 6. Uncontrolled infection 7. Uncontrolled intercurrent disease 8. Psychogenic disorder 9. Patients who are suitable candidates by legally 10. Pregnant or breast-feeding patients 11. Patients who are unsuitable candidates by doctor's decision 12. MMMT 13. Cancer tissue is not confirmed during surgery after neo-adjuvant chemotherapy