title: Neoadjuvant intraperitoneal chemotherapy with paclitaxel for the radical surgical treatment of peritoneal carcinomatosis in ovarian cancer: a prospective pilot study.
abstract: OBJECTIVE
  The admitted benefits of intraperitoneal chemotherapy during postoperative administration for the treatment of peritoneal carcinomatosis from ovarian origin are limited by their associated morbidity and restricted diffusion by the presence of multiple intra-abdominal adherences. The purpose of the study was to evaluate the security, effectiveness, and cytoreduction optimization of intraperitoneal paclitaxel administration previously to radical surgery/peritonectomy/HIPEC (hyperthermic intraoperative intraperitoneal chemotherapy) either in monotherapy or combined with intravenous carboplatin.
  
  
  METHODS
  Prospective pilot study of 10 patients with ovarian peritoneal carcinomatosis in stage IIIc-FIGO without previous treatment. After staging of the diseases by laparoscopy, five patients received paclitaxel by weekly intraperitoneal administration (60 mg/m(2), 10 cycles), and other five patients additionally received intravenous carboplatin every 21 days (AUC 6, 4 cycles). Subsequently radical surgery/peritonectomy with HIPEC was performed.
  
  
  RESULTS
  The presence of moderate abdominal pain was the most common (70%) side effect associated with neoadjuvant paclitaxel intraperitoneal administration. The intravenous carboplatin administration was not associated with significant increase in adverse effects. It boosted intraperitoneal paclitaxel-associated antitumoral activity with a high average decrease in Index Cancer Peritoneal (21.2 vs. 14.4, P = 0.066) and CA 125(1,053 vs. 346, P = 0.043). All the patients who received combined neoadjuvant chemotherapy obtained R0 cytoreduction. Five-year overall survival was 62%.
  
  
  CONCLUSIONS
  The intraperitoneal paclitaxel weekly administration combined with intravenous carboplatin administration prior to radical surgery/peritonectomy with HIPEC is a safe and effective option in the treatment of ovarian peritoneal carcinomatosis. This study shows the possibility to investigate other forms of intraperitoneal chemotherapy and their combinations thoroughly.
authors.affiliation: Department of General Surgery. Surgical Oncology Unit, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain. fcocris@telefonica.net
authors.forename: Francisco C
authors.initials: FC
authors.lastname: Muñoz-Casares
authors.forename: Sebastián
authors.initials: S
authors.lastname: Rufián
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Arjona-Sánchez
authors.forename: María J
authors.initials: MJ
authors.lastname: Rubio
authors.forename: Rafael
authors.initials: R
authors.lastname: Díaz
authors.forename: Ángela
authors.initials: Á
authors.lastname: Casado
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Naranjo
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Díaz-Iglesias
authors.forename: Rosa
authors.initials: R
authors.lastname: Ortega
authors.forename: María C
authors.initials: MC
authors.lastname: Muñoz-Villanueva
authors.forename: Jordi
authors.initials: J
authors.lastname: Muntané
authors.forename: Enrique
authors.initials: E
authors.lastname: Aranda
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002277:Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel