Weekly induction intraperitoneal chemotherapy after primary surgical cytoreduction in patients with advanced epithelial ovarian cancer

BACKGROUND: Traditional intraperitoneal (IP) therapy administered simultaneously with intravenous (IV) chemotherapy in the primary setting has been well documented. This retrospective study was conducted to investigate the role of weekly IP therapy as an inducing intervention before front-line IV chemotherapy, particularly in patients with bulky residual disease after surgery. METHODS: A total of 426 patients with advanced ovarian cancer treated between 1990 and 1999, were reviewed. Follow-up data were available in 409 patients. Of whom, 230 patients received postoperative weekly IP therapy with a median cycles of 4, other 179 patients who did not receive any IP therapy were used as the control group. RESULTS: The median age of the patients was 51 years (range, 20–77 years). One hundred eighty-nine patients with stage III disease and 41 patients with stage IV disease were treated with postoperative IP therapy, respectively. Complications and toxicity were observed in 68 patients (29.5%), but there were no grade 4 toxicities and no patients died of complications or toxicities. In patients with residual disease > 1 cm, the median survival of those with IP delivery of chemotherapy and those without was 21.6 months and 18.8 months, respectively (hazard ratio [HR]= 0.69, P = 0.02). Whereas, in patients with residual disease ≤ 1 cm, the median survival was 46.8 months and 37.6 months, respectively (HR= 0.73, P = 0.09). Multivariate analysis suggested that the factors age ≤ 60 years, stage III, IP therapy and paclitaxel as front-line chemotherapy were associated with a better prognosis for patients with advanced ovarian cancer. CONCLUSION: Weekly postoperative IP therapy as an inducing intervention is practical for both physicians and patients with acceptable complications and associated with a lengthened survival of patients with advanced ovarian cancer. Whether this arm can be used in lieu of a traditional one needs further randomized trial to confirm the preliminary results.