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abstract
May 21, 2016
Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center
Highlights
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- IP chemotherapy was given to 79% of eligible patients in our cohort.
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- Potentially modifiable factors were identified as prohibiting IP chemotherapy use.
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- Postoperative status is the most cited reason for giving IV-only chemotherapy.
Abstract
Objective
Studies
have demonstrated improved ovarian cancer survival with the
administration of a combination of intravenous (IV) and intraperitoneal
(IP) chemotherapy following optimal cytoreduction. Despite this, IV/IP
chemotherapy is not uniformly used. In this retrospective cohort study,
we assessed the documented reasons for giving IV-only chemotherapy.
Methods
All
patients who had optimal primary cytoreductive surgery for stage III
ovarian, fallopian tube, or primary peritoneal carcinoma, met
eligibility criteria for GOG-172, and received primary chemotherapy at
our institution between 2006 and 2013 were identified. Patients who
received at least one cycle of adjuvant IV/IP therapy were included in
the IP group. Patient characteristics, treatment information, and reason
cited for not administering IP therapy were collected.
Results
Of
the patients evaluated, 330 met inclusion criteria. The majority
(n = 261, 79%) received at least one IV/IP cycle (median, 6; range,
1–6), and 62% completed 6 cycles. The most common reason for giving
IV-only therapy was postoperative status (i.e., delayed wound healing,
performance status), accounting for 18 (26%) of the 69 IV-only patients
(5% of the entire cohort). Other cited reasons were baseline
comorbidities (15%) and IP port complications (12%). Receipt of
≥ 1 cycle of IP chemotherapy (HR 0.51; 95% CI, 0.32–0.80) and no gross
residual disease (HR 0.47; 95% CI, 0.31–0.71) were associated with
improved overall survival.
Conclusion
Potentially
modifiable factors identified as leading to the use of IV-only
chemotherapy were postoperative status and IP port complications, which
if altered, could potentially lead to increased IP chemotherapy use.
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