Abstract
<jats:p>Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers chemotherapy directly to the peritoneal surface at a controlled high temperature; the combination produces both a regional drug-concentration advantage and an additive cytotoxic effect from heat. The rationale in gynecologic oncology rests on two observations: epithelial ovarian cancer (EOC) spreads predominantly within the peritoneal cavity, and systemic chemotherapy controls this compartment incompletely. Among randomized trials, OVHIPEC-1 demonstrated an overall survival gain when HIPEC was added to interval cytoreductive surgery for stage III EOC; this finding continues to represent the highest-quality evidence in the field. At primary cytoreductive surgery, neither OVHIPEC-2 nor KOV-HIPEC-01 detected a survival difference. In recurrent disease, two phase III trials published in 2024 produced opposite results: CHIPOR reported improved overall survival when HIPEC followed second-line platinum re-induction and complete cytoreduction, whereas HORSE found no benefit when HIPEC was added to upfront secondary cytoreduction. This chapter summarizes the historical context, pharmacological basis, technical variables, current trial evidence, patient selection, perioperative morbidity, and emerging directions, including pressurized intraperitoneal aerosol chemotherapy (PIPAC).</jats:p>