Combination chemotherapy with paclitaxel and intraperitoneal cisplatin for ovarian cancer with disseminated lesions in the peritoneum and the diaphragm.
BACKGROUND
In ovarian cancer, the management of micrometastases disseminated in the peritoneal cavity is extremely important. We performed intravenous paclitaxel (PAC) infusion combined with cisplatin (CDDP) intraperitoneal infusion for progressive ovarian cancer.


METHODS
Twelve patients with progressive epithelial ovarian cancer (FIGO IIIc), which was resected using an optimal method at primary surgery, except for disseminated lesions in the peritoneum and the diaphragm, were studied. At primary surgery, a reservoir was placed in the peritoneal cavity. If metastases were identified in the diaphragm, then another reservoir was also placed in the subdiaphragm (double reservoirs). The basic regimen was set at 175 mg/m(2) with divided doses of PAC and 75 mg/m(2) CDDP by intraperitoneal injection. When a double reservoir was used, 30 mg/m(2) of subdiaphragmatic CDDP and 45 mg/m(2) of intraperitoneal CDDP were administered. The patients received five courses of this regimen. The response to the therapy was evaluated with tumor markers, and by using cytodiagnoses on the peritoneal washing fluid collected from the reservoirs.


RESULTS
After five courses of the chemotherapy, the tumor marker levels and cytodiagnoses of all patients became negative. With reference to adverse effects, grade 3-4 neutropenia was detected in 2 patients (16.6%), peripheral neuropathy was detected in 4 patients (33.3%), and alopecia was detected in 11 patients (91.6%). The median follow-up period was 29.2 months and median progression-free survival was 25.6 months.


CONCLUSIONS
The combination chemotherapy with intravenous PAC and intraperitoneal CDDP was effective on ovarian cancer with disseminated lesions in the peritoneum and the diaphragm, having only mild adverse effects.
Terauchi
Fumitoshi
F
Second Department of Obstetrics and Gynecology, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo 153-8515, Japan. teralfa@aol.com
Moritake
Tetsuya
T
Yamamoto
Yasuhiro
Y
Ogura
Hisao
H
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D018395:CA-19-9 Antigen / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002945:Cisplatin / Q000008:administration & dosage; D003964:Diaphragm; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000556:secondary*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary*
D000972:Antineoplastic Agents, Phytogenic; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D017239:Paclitaxel; D002945:Cisplatin