title: Update on Intraperitoneal Chemotherapy for the Treatment of Epithelial Ovarian Cancer.
abstract: Surgical treatment and chemotherapy administration in women with epithelial ovarian cancer is more controversial today than at any point in the last 3 decades. The use of chemotherapy administered intraperitoneally has been particularly contentious. Three large randomized phase III studies, multiple meta-analyses, and now real-world data have demonstrated substantial outcome benefit for the use of chemotherapy administered intraperitoneally versus intravenously for first-line postoperative treatment of optimally debulked advanced ovarian cancer. Unfortunately, for each of these randomized studies, there was scope to either criticize the design or otherwise refute adoption of this route of administration. As a result, the uptake has been variable in North America, although in Europe it has been practically nonexistent. Reasons for this include unquestionable additional toxicity, more inconvenience, and extra cost. However, 10-year follow up of these studies demonstrates unprecedented survival in the intraperitoneal arm (median survival 110 months in patients with completely debulked stage III), raising the possibility that by combining maximal debulking surgery with postoperative intraperitoneal chemotherapy it may be possible to bring about a step change in the outcomes for these patients. In this review, we discuss the rationale for administering chemotherapy intraperitoneally, the merits of the main randomized clinical trials, the evidence regarding optimal regimes, issues of toxicity, port considerations, and reasons for lack of universal adoption. We also explore potential clinical and biologic factors that may be useful for patient selection in the future.
authors.affiliation: From the Edinburgh Cancer Research Centre, Medical Research Council, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Stephenson Cancer Center, University of Oklahoma, Health Sciences Center, Oklahoma City, OK; Faculty of Medicine, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Canada.
authors.forename: Charlie
authors.initials: C
authors.lastname: Gourley
authors.affiliation: From the Edinburgh Cancer Research Centre, Medical Research Council, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Stephenson Cancer Center, University of Oklahoma, Health Sciences Center, Oklahoma City, OK; Faculty of Medicine, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Canada.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.affiliation: From the Edinburgh Cancer Research Centre, Medical Research Council, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom; Stephenson Cancer Center, University of Oklahoma, Health Sciences Center, Oklahoma City, OK; Faculty of Medicine, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Canada.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Mackay
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D065426:Cytoreduction Surgical Procedures; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007263:Infusions, Parenteral; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011184:Postoperative Period; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents