Despite the efficacy of intravenous (IV) platinum and paclitaxel chemotherapy, more than 75% of patients with stage iii and iv eoc ultimately relapse and die of their disease 2 .
IntraperItoneal ChemotherapyThe peritoneal cavity is the principle site of spread and recurrence in women with eoc. Intraperitoneal (IP) administration of chemotherapy, as a means of increasing the dose intensity delivered to the tumour while minimizing systemic toxicity, is therefore an attractive therapeutic approach 3 . Advantages of this administration route include high IP concentration and longer half-life of the drug in the peritoneal cavity than are observed with IV administration. For cisplatin, the most commonly used IP chemotherapeutic agent, IP administration translates into an exposure in the peritoneal cavity that is greater by a factor of 10-20 than is achievable with the IV route 4 . Publication of the Gynecologic Oncology Group (gog) 172 study, which demonstrated a significant overall survival benefit (17.4 months) for IP paclitaxel-IV cisplatin over conventional IV chemotherapy in women with stage iii eoc undergoing "upfront" optimal (≤1 cm) debulking surgery prompted a re-evaluation of IP chemotherapy 5 . The U.S. National Cancer Institute (nci) reviewed data from seven randomized trials comparing IV-IP with standard IV administration of chemotherapy in women who had undergone primary debulking surgery (Table i). On average, IP-IV chemotherapy was associated with a 21.6% decrease in risk of death (hazard ratio: 0.78; 95% confidence interval: 0.69 to 0.89) [5][6][7][8][9][10][11][12] . They concluded that IP-IV chemotherapy should be considered a standard of care for a select group of women with eoc.Despite the favourable outcomes, IP chemotherapy has not been universally adopted. In all seven studies, toxicity was higher in the experimental arm, particularly when considered in comparison with standard IV carboplatin and paclitaxel. Dropout rates were high, with completion rates ranging from 71% (gog 114) to 42% (gog 172). The optimal aBStraCt Three large randomized clinical trials have shown a survival benefit in women with stage iii epithelial ovarian cancer (eoc) who receive intraperitoneal (IP) chemotherapy after optimal primary debulking surgery. The most recent Gynecologic Oncology Group study, gog 172, showed an improvement in median overall survival of approximately 17 months. That result led to a U.S. National Cancer Institute (nci) clinical announcement recommending that IP chemotherapy be considered for this group of women with eoc. However, IP chemotherapy is associated with increased toxicity, and rates for completion of treatment are low (42% in gog 172). The optimal IP regimen and duration of treatment has yet to be defined. Women undergoing chemotherapy before optimal debulking surgery were not included in the studies or in the nci clinical announcement. The National Cancer Institute of Canada Clinical Trials Group has developed a protocol for a randomized phase ii/iii study which will examine whether I...