What is the role of intraperitoneal chemotherapy in the treatment of ovarian cancer?

Updated: Aug 10, 2020
  • Author: Andrew E Green, MD; Chief Editor: Yukio Sonoda, MD  more...
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Use of chemotherapy agents instilled into the peritoneal cavity has the theoretical advantage that much higher concentrations can be obtained locally without the risk of adverse systemic effects; however, the agents are unable to penetrate more than a few millimeters. Results from randomized clinical trials suggest that in patients with optimally debulked disease, intraperitoneal administration of chemotherapy (cisplatin) is superior to intravenous administration. [72, 73] Meta-analyses have confirmed that intraperitoneal chemotherapy is associated with improved survival, but also with more toxicity. [74, 75]

A retrospective analysis of Gynecologic Oncology Group protocols 114 and 172 found that in patients with advanced ovarian cancer, median survival with intraperitoneal therapy was 61.8 months, compared with 51.4 months for intravenous therapy. Intraperitoneal therapy was associated with a 23% decreased risk of death, and with improved survival in patients with gross residual (≤1 cm) disease. Risk of death decreased by 12% for each cycle of intraperitoneal chemotherapy completed. [72] Thus, intraperitoneal chemotherapy should be strongly considered for the treatment of front-line disease following surgery where 5 mm or less of residual disease exists, and perhaps for more advanced cancers.

Jaaback et al found that intraperitoneal chemotherapy increases overall survival and progression-free survival in advanced ovarian cancer; however, catheter-related complications and toxicity must be considered in the treatment decision. [76] Patients receiving adjuvant intraperitoneal chemotherapy are more likely to have recurrences outside the abdominal cavity, according to a study by Tanner et al. [77]

Intraperitoneal chemotherapy may cause more adverse effects for the patient, and administration requires the placement of a subcutaneous tube into the peritoneal cavity (an intraperitoneal port); this is associated with a number of complications, including infection, blockage, retraction out of the peritoneal cavity, and discomfort. Modifications to improve the tolerability of intraperitoneal chemotherapy that are being examined include reduction of the total 3-hour amount of cisplatin given. [78]

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