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LETTER TO EDITOR
Year : 2010  |  Volume : 47  |  Issue : 2  |  Page : 225-226
 

Feasibility of intraperitoneal chemotherapy in advanced epithelial ovarian cancer


1 Department of Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai - 400 012, India
2 Department of Medical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai - 400 012, India

Date of Web Publication5-May-2010

Correspondence Address:
A Maheshwari
Department of Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.63007

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How to cite this article:
Maheshwari A, Gupta S, Prabhash K, Tongaonkar H B. Feasibility of intraperitoneal chemotherapy in advanced epithelial ovarian cancer. Indian J Cancer 2010;47:225-6

How to cite this URL:
Maheshwari A, Gupta S, Prabhash K, Tongaonkar H B. Feasibility of intraperitoneal chemotherapy in advanced epithelial ovarian cancer. Indian J Cancer [serial online] 2010 [cited 2021 Jan 23];47:225-6. Available from: https://www.indianjcancer.com/text.asp?2010/47/2/225/63007


Sir,

Intraperitoneal chemotherapy (IPCT) has been shown to offer some survival advantage over intravenous chemotherapy (IVC) in optimally cytoreduced epithelial ovarian cancer (EOC) patients as per the results of randomized trials and meta-analyses. [1],[2],[3] However, despite its superiority, IPCT has not gained wide acceptance due to high toxicity rates.

We did a prospective evaluation of the feasibility of IPCT in patients with advanced EOC after optimal primary or interval cytoreduction. Eleven patients were accrued from August 2007 till date. Nine patients had interval surgery after NACT (paclitaxel-carboplatin) and two had primary surgery. BardPort (9.6 F) with peritoneal catheter was used for instilling IPCT, which was inserted at the time of surgery in all patients. The IPCT protocol was: Paclitaxel 135 mg/m 2 intravenous infusion over 24 h on D1, Cisplatin 100 mg/m 2 in 2 L of normal saline intraperitoneal infusion on D2 and Paclitaxel 60 mg/m 2 in 2L of normal saline intraperitoneal infusion on D8.

The mean age was 48.5 years (range, 25-66). The median pretreatment serum CA-125 level was 4011 U/mL. The total number of IPCT cycles planned in 11 patients was 36, of which 30 cycles (85.8%) could be given; reasons for not giving IPCT were related to toxicity in 2# and unrelated in 4#. The D8 chemotherapy (IP paclitaxel) could not be given in 11# (36.7%) and dose reduction by ≥25% was required in 2# (6.7%), due to significant toxicity. Overall, 25 IP # (83.3%) resulted in significant toxicity. Various toxicities (grade 3/4) were: vomiting in 13# (43.3%), abdominal pain in 10# (33.3%), diarrhea in 3# (10%), dyselectrolytemia in 8# (26.7%), neutropenia in 12# (40%), febrile neutropenia in 3# (10%), anemia in 5# (16.7%), thrombocytopenia in 1# (3.3%) and PORT site extravasation of cisplatin in 1# (3.3%). There was no treatment related mortality. Of note, there was a significant incidence of hyponatremia, hypokalemia and hypomagnesemia that required electrolyte repletion for several days. The author's current practice is to prophylactically administer these electrolytes in the inpatient setting. The toxicity in our study compares with GOG-172 [1] in which only 42% of the patients could complete all planned doses of IPCT.

The current analysis shows that IPCT is feasible after primary and interval cytoreductive surgery. However, the currently used protocol resulted in significant toxicity and a significant proportion of patients could not take D8 of IPCT. Intraperitoneal route needs to be explored with better tolerated schedules, doses and agents.

 
  References Top

1.Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006;354:34-43.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Fujiwara K, Armstrong D, Morgan M, Markman M. Principles and practice of intraperitoneal chemotherapy for ovarian cancer. Int J Gynecol Cancer 2007;17:1-20  Back to cited text no. 2      
3.Markman M, Walker JL. Intraperitoneal chemotherapy of ovarian cancer: A review, with a focus on practical aspects of treatment. J Clin Oncol 2006;24:988-94.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  




 

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