Intraperitoneal chemotherapy in ovarian carcinoma

Current standard treatment of ovarian carcinoma includes primary cytoreductive surgery followed by postoperative first-line intravenous combination chemotherapy with taxol and cisplatin. Despite a remarkable high initial response rate, the tumor recurs in most patients and its response to further surgery and additional lines of intravenous chemotherapy is dismal. Intraperitoneal chemotherapy is gaining impetus in relation to ovarian cancer since, even in an advanced stage or recurrence, it usually remains confined to the peritoneal cavity, Intraperitoneal chemotherapy allows direct exposure of the tumor to high concentrations of cytotoxic drugs without increasing systemic toxicity. A cytotoxic drug is considered qualified for intraperitoneal administration if its molecular weight is high enough not to permit an easy transfer through the peritoneal/plasma barrier. Intraperitoneal chemotherapy can be administered intraoperatively and/or post-operatively. The most common complication of intraperitoneal chemotherapy is peritonitis. A significant advantage of intraperitoneal first-line chemotherapy over intravenous first-line chemotherapy was demonstrated in only two of five phase III clinical trials. The results of eight phase II studies showed a borderline advantage of intraperitoneal consolidation chemotherapy over intravenous consolidation chemotherapy, or no consolidation chemotherapy. In 13 phase II studies, a borderline advantage of intraperitoneal salvage chemotherapy over intravenous salvage chemotherapy was noticed only in patients with minimal residual disease. In five stage I/II studies, a vague advantage of intraperitoneal hyperthermic chemotherapy over other treatments was noticed. However, this treatment was well-tolerated by the patients. All studies demonstrated that patients with minimal resedual disease are the best candidates for intraperitoneal chemotherapy. Additional phase III studies are required in order to reinforce the status of intraperitoneal chemotherapy in the treatment of ovarian carcinoma.