ABSTRACT
We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.
Subject(s)
Cisplatin/administration & dosage , Ovarian Neoplasms/drug therapy , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cisplatin/adverse effects , Combined Modality Therapy , Cytarabine/administration & dosage , Female , Humans , Infusions, Parenteral , Ovarian Neoplasms/surgery , Reoperation , Survival AnalysisABSTRACT
Intraperitoneal chemotherapy with a totally implantable catheter was performed in 42 patients with advanced ovarian cancer who received 178 courses of chemotherapy administered in 2 l of solution. Major complication was inflow obstruction due to fibrosis around the catheter observed in 10 patients, 23.8% of the cases. Other complications were: leakage 3 (7.1%), pain 3 (7.2%), infection 3 (7.1%) and rectal perforation 1 (2.4%). Overall, these complications occurred in 15 patients (35.7%) and were the cause of treatment interruption in 7 (16.7%). Outflow obstruction which occurred in 23 patients (54.8%), did not create discomfort and could not be considered as a complication. Despite the problems, intraperitoneal chemotherapy with a totally implantable catheter appeared feasible in at least 80% of the patients.
Subject(s)
Antineoplastic Agents/administration & dosage , Catheters, Indwelling , Ovarian Neoplasms/drug therapy , Adult , Aged , Antineoplastic Agents/therapeutic use , Catheterization/adverse effects , Female , Humans , Infusions, Parenteral , Middle AgedABSTRACT
We studied a series of 42 patients with advanced ovarian cancer who received intraperitoneal chemotherapy post second-look laparotomy. High-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g) achieved 47% response rate. Median overall survival from second-look laparotomy was 44 months with cisplatin (36 cases), 15 months with carboplatin (600 mg/m2, 5 cases) and not reached at 3 yrs with mitoxantrone (25 mg/m2, 8 cases). Median overall and progression-free survival from second-look laparotomy were 44 and 39 months respectively in complete responders (15 cases), 20 months and 9 months where residual tumor less than 2 cm (21 cases), 22 and 12 months where tumor greater than 2 cm (6 cases). There was a significant difference in survival (P = 0.01) and progression-free survival (P = 0.002) between complete responders and patients whose tumor was less than 2 cm. Toxicity was acceptable except for carboplatin with constant grade 4 leukocytes or platelets toxicity. It was not demonstrated that high-dose intraperitoneal chemotherapy given post second-look laparotomy will improve survival in advanced ovarian cancer. Further studies of polychemotherapy or early administration are needed.