title: Comparative study of grade 3/4 toxicity associated with intraperitoneal chemotherapy administered after primary versus interval surgical debulking in ovarian cancer.
abstract: OBJECTIVE
  To determine the prevalence of grade 3 or 4 toxicity associated with intraperitoneal (IP) chemotherapy subsequent to primary surgical debulking compared to post-neoadjuvant chemotherapy and interval debulking in advanced ovarian cancer.
  
  
  METHODS
  Patients receiving IP chemotherapy from 2006 to 2010 were reviewed. Study cohort was stratified by initial treatment (upfront surgery vs neoadjuvant chemotherapy). The National Cancer Institute toxicity grading scale was used to assess treatment-related toxicities immediately before each cycle. The χ² test was used to check for association between categorical variables.
  
  
  RESULTS
  Thirty-three patients received IP chemotherapy after optimal debulking. Sixteen patients had upfront surgery. The total number of IP chemotherapy cycles administered was 134. Significantly, more patients treated with IP chemotherapy after intravenous neoadjuvant chemotherapy experienced fatigue (P=0.038) compared to those treated after upfront surgery. During the course of IP regimen, the patients having upfront surgery tended to experience more grade 3/4 hematologic toxicities (P=0.06) and abdominal pain (P=0.08). Twenty-four (73%) of 33 patients completed all prescribed IP chemotherapy cycles. There was no significant difference between the 2 groups in need for dose reduction or delays, use of paclitaxel on day 8, neurologic/gastrointestinal/metabolic toxicities, and IP port complications.
  
  
  CONCLUSIONS
  Intraperitoneal chemotherapy can be given after optimal primary surgery or interval surgery after neoadjuvant chemotherapy with similar toxicity profile. Toxicity data can be used to plan for optimal IP chemotherapy delivery, patient counseling, and ongoing supportive care.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada. tle@ottawahospital.on.ca
authors.forename: Tien
authors.initials: T
authors.lastname: Le
authors.forename: Hassan
authors.initials: H
authors.lastname: Latifah
authors.forename: Lynne
authors.initials: L
authors.lastname: Jolicoeur
authors.forename: Wylam
authors.initials: W
authors.lastname: Faught
authors.forename: Johanne
authors.initials: J
authors.lastname: Weberpals
authors.forename: Laura
authors.initials: L
authors.lastname: Hopkins
authors.forename: Michael
authors.initials: M
authors.lastname: Fung-Kee-Fung
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000453:epidemiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007274:Injections, Intraperitoneal / Q000009:adverse effects; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies