Intraperitoneal chemotherapy in ovarian cancer: a review of tolerance and efficacy

Abstract

PurposeTo review the two main approaches of intraperitoneal (IP) chemotherapy delivery in ovarian cancer: postoperative adjuvant IP chemotherapy after cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsA literature search was conducted to identify studies that employed postoperative adjuvant IP chemotherapy after CRS or combined CRS and intraoperative HIPEC in patients with ovarian cancer. Data of interest included chemotherapy protocol, morbidity and mortality, and survival data.ResultsThree large randomized controlled trials comprising 707 patients with advanced ovarian cancer who received postoperative adjuvant IP chemotherapy were reviewed. Morbidity rate ranged from 56% to 94% in IP chemotherapy, and mortality rate ranged from 1% to 2%. Median disease-free survival ranged from 24 to 28 months, and overall survival ranged from 49 to 66 months. Planned chemotherapy completion rates ranged from 42% to 71%. Twenty-four nonrandomized studies that reported HIPEC comprised 1167 patients with both advanced and recurrent ovarian cancer. In patients with advanced ovarian cancer, mortality ranged from 0% to 5%, minor morbidity ranged from 16% to 90%, and major morbidity ranged from 0% to 40%. Median disease-free survival ranged from 13 to 56 months, and overall survival ranged from 14 to 64 months. Survival at 5 years ranged from 35% to 70%. In patients with recurrent ovarian cancer, the mortality rate ranged from 0% to 10%, minor morbidity ranged from 7% to 90%, and major morbidity ranged from 0% to 49%. Median disease-free survival ranged from 13 to 24 months and overall survival from 23 to 49 months. Survival at 5 years ranged from 12% to 54%.ConclusionThere is level-one evidence suggesting the benefit of postoperative adjuvant intraperitoneal chemotherapy for patients with advanced ovarian cancer after cytoreductive surgery, albeit catheter-related complications resulted after treatment discontinuation. Studies report the use of HIPEC predominantly in the setting of recurrent disease and have demonstrated encouraging results, which merits further investigation in future clinical trials.

Complications of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Advanced Ovarian Malignancies: First Indian Study

“…Average surgery duration was 9 ± 2.7 h (range 5. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Mean perfusion temperature used was (42 ± 0.49°C).…”

“…But it is currently remarkably minimally utilized [15] despite a 21 % reduction in risk of death [16]. HIPEC has the advantage of not requiring post-operative intraperitoneal chemotherapy, and in a small case/control study it achieved significantly lower recurrence and better survival [17].…”

Update on the management and the role of intraperitoneal chemotherapy for ovarian cancer

“…Although peritoneal carcinomatosis has always been a poor prognostic factor, it ceases to be a factor of much importance if complete CRS can be achieved [31,40]. CRS and HIPEC provide the combined benefits of surgical eradication and effective chemotherapy, and can be performed with acceptable morbidity and mortality [41]. Further trials are being undertaken to examine its role in the primary, as well as recurrent settings of advanced ovarian cancer and to determine the ideal drug combinations and dosages [42][43][44].…”

Peritoneal Carcinomatosis from Ovarian Cancer

“…In addition, related complications cause a significant reduction of complete application of both procedures (i.e. IP-CHT and IV-CHT) [55].…”