Many of you have asked me about the role of chemotherapy delivered directly in to the abdomen (Intraperitoneal chemotherapy) with ovarian cancer. Here is a quick summary:

1) Results from a large clinical trial suggest a significant survival benefit for Intraperitoneal (IP) chemo as compared to all intravenous chemotherapy in a SUBSET of women with optimally reduced tumor after surgery (to <0.5 cm), but at the expense of significant toxicity.

2) A similar conclusion was reached in two separate meta-analyses of randomized trials comparing standard intravenous therapy with chemotherapy that included a component of IP administration.

3) National Cancer Institute suggests that IP chemotherapy be strongly considered for women with small volume residual tumor after maximal surgical resection for stage III disease. A thorough discussion with the patient about the potential benefits and toxicities associated with such an approach is mandatory. At least for the present, a standard intravenous regimen of paclitaxel plus carboplatin is an acceptable alternative to IP therapy for these patients because of the toxicity issues. Ongoing studies will seek to identify effective yet more tolerable IP regimens for further study in subsequent phase III trials. AGAIN: Women with optimally reduced stage III ovarian cancer and a good performance status should at least be counseled regarding this potentially superior option of therapy.

What about Intraperitoneal Chemo for those with RECURRENCE of ovarian cancer after initial treatment? In a review of salvage therapy for ovarian cancer, Intraperitoneal (IP) therapy with platinum was recommended as second-line therapy for patients with platinum-sensitive relapsed ovarian cancer.  However, the basis for this preference is not clear. At present, there seems to be little role for IP chemotherapy in the management of patients with platinum-resistant disease or patients with residual tumors of any size (especially larger than 2 cm).

Confusing I know, but discussing chemotherapy regimens always is. Let us know your experience with IP chemotherapy.

Dr O.