title: Intraperitoneal Chemotherapy in Patients Pretreated for Ovarian Cancer Matched with Patients Treated with Parenteral Chemotherapy.
abstract: Our aim was to analyze the impact of intraperitoneal chemotherapy (IPC), administered with direct peritoneal puncture, on the survival of patients with pretreated ovarian cancer in a real-life setting.
  
  
  
  This was a retrospective study comparing patients with advanced ovarian cancer treated with IPC (N=33) and patients treated with standard intravenous (i.v.) chemotherapy matching cases for known prognostic factors (age, platinum sensitivity, histological subgroup and grade). Data were then analyzed for survival with nested Cox multivariate regression.
  
  
  
  The case matching resulted in two homogeneous cohorts by age, platinum sensitivity, resistance to therapy and histology. When analyzed by hazard ratio (HR), the number of previous treatments and IPC vs. i.v. therapy were significant (HR=1.97 for i.v. and HR=1.90 for each incremental previous treatment line, multivariate p<0.001). When analyzing the patients with fewer than three previous treatment lines, IPC conferred a survival advantage of about 2.2 months (IPC=10.0 vs. i.v.=7.8 months, p=0.011). However, the survival advantage in heavily pre-treated patients (with three or more previous treatments) was not significant. One case, pre-treated with more lines of chemotherapy, with renal failure after intraperitoneal cisplatin was followed by death. None of the patients had bowel sub-occlusions and we recorded a lower incidence of local toxicity, such as cellulite, with IPC (two out of 33 cases). Two patients thereafter refused IPC due to abdominal pain.
  
  
  
  Our findings confirm that IPC is an effective approach compared to systemic chemotherapy for advanced ovarian cancer, even in pre-treated patients, including platinum-resistant cases. The survival benefit appears to be confined to non-heavily treated patients. Overall, direct intraperitoneal drug injection (without permanent devices) appears to be feasible, safe and possibly advantageous.
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy ornella.nicoletto@ioveneto.it.
authors.forename: Maria Ornella
authors.initials: MO
authors.lastname: Nicoletto
authors.affiliation: Medical School, University of Padua, Padua, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Casarin
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Baldoni
authors.affiliation: Laboratory of Methodology for Clinical Research, Department of Oncology, Mario Negri Pharmacological Research Institute, Milan, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Rulli
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Tasca
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Zora
authors.initials: Z
authors.lastname: Baretta
authors.affiliation: Oncology and Hematology Unit, Mirano Hospital, Venice, Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Artioli
authors.affiliation: Medical Oncology Unit 1, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Oncology and Hematology Unit, Mirano Hospital, Venice, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappetta
authors.affiliation: Laboratory of Methodology for Clinical Research, Department of Oncology, Mario Negri Pharmacological Research Institute, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.affiliation: Medical School, University of Padua, Padua, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Randon
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Valpione
authors.affiliation: Department of Obstetrics and Gynecology, University of Padua, Padua, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Litta
authors.affiliation: Medical Oncology Unit 2, Veneto Institute of Oncology - IRCCS, Padua, Italy.|Medical School, University of Padua, Padua, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: Pierfranco
authors.initials: P
authors.lastname: Conte
authors.affiliation: Oncological Surgery Unit, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.affiliation: Radiology Unit, Veneto Institute of Oncology - IRCCS, Padua, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Aliberti
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D017239:Paclitaxel; D002945:Cisplatin
keywords: Intraperitoneal treatment; parenteral chemotherapy; pre-treated ovarian cancer