Intraperitoneal chemotherapy in the first-line treatment of women with stage III epithelial ovarian cancer

A Systematic Review With Metaanalyses

Authors

  • Laurie Elit MD,

    1. Department of Obstetrics and Gynecology, Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada
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  • Thomas K. Oliver BA,

    Corresponding author
    1. Department of Clinical Epidermiology and Biostatistics, Program in Evidence-based Care, McMaster University, Hamilton, Ontario, Canada
    • Department of Clinical Epidermiology and Biostatistics, Program in Evidence-based Care, McMaster University, 1280 Main Street West, DTC, 3rd floor, Hamilton, Ontario, L8S 4L8 Canada
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    • Fax: (905) 522-7681

  • Allan Covens MD,

    1. Department of Obstetrics and Gynecology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada
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  • Janice Kwon MD,

    1. Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
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  • Michael Fung-Kee Fung MD,

    1. Department of Obstetrics and Gynecology, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada
    2. Department of Surgery, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada
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  • Holger W. Hirte MD,

    1. Department of Obstetrics and Gynecology, Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada
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  • Amit M. Oza MD

    1. Department of Obstetrics and Gynecology, Princess Margaret Hospital, Toronto, Ontario, Canada
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  • See related article on pages 645–9, this issue.

Abstract

Because women with advanced ovarian cancer have poor outcomes, it is imperative to continue exploring for novel therapies. The opportunity for intraperitoneal treatment, especially in the subgroup of patients with minimal residual disease, in which the intraperitoneal approach may have a biologic rationale for benefit over and above the standard intravenous route, needs to be explored to the fullest extent. The MEDLINE, EMBASE, and Cochrane Library databases were searched up to January 2006 for randomized trials that compared first-line intraperitoneal-containing chemotherapy with first-line intravenous chemotherapy in the treatment of women with stage III epithelial ovarian cancer. Seven randomized, controlled trials were identified, including 3 large Phase III trials and 4 smaller randomized trials. The 3 large Phase III trials detected statistically significant overall survival benefits with intraperitoneal cisplatin-containing chemotherapy compared with intravenous chemotherapy alone. The improvements in survival were 8 months, 11 months, and 16 months, respectively. Pooled analysis from 6 of the 7 randomized trials confirmed the survival effect with intraperitoneal chemotherapy compared with intravenous chemotherapy alone (relative risk, 0.88; 95% confidence interval, 0.81–0.95). Severe adverse events and catheter-related complications with intraperitoneal chemotherapy were significantly more common and often were dose-limiting. The results from this review indicated that cisplatin-containing intraperitoneal chemotherapy should be offered to patients on the basis of significant improvements in overall survival. The appropriate clinical and institutional multidisciplinary facilities are needed for the safe delivery of this treatment in optimally debulked patients. Further research is needed concerning specific aspects of the treatment, such as optimal agent, dose, and scheduling. Cancer 2007;109:692–702. © 2007 American Cancer Society.

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