abstract
BACKGROUND:
Our
aim was to analyze the impact of intraperitoneal chemotherapy (IPC),
administered with direct peritoneal puncture, on the survival of
patients with
pretreated ovarian cancer in a real-life setting.
PATIENTS AND METHODS:
This
was a retrospective study comparing patients with advanced ovarian
cancer treated with
IPC (N=33) and patients treated with standard
intravenous (i.v.) chemotherapy matching cases for known prognostic
factors (age, platinum sensitivity, histological subgroup and grade).
Data were then analyzed for survival with nested Cox multivariate
regression.
RESULTS:
The
case matching resulted in two homogeneous cohorts by age, platinum
sensitivity, resistance to therapy and histology. When analyzed by
hazard ratio (HR), the number of previous treatments and IPC vs. i.v.
therapy were significant for i.v. and for each
incremental previous treatment line, multivariate. When
analyzing the patients with fewer than three previous treatment lines,
IPC conferred a survival advantage of about 2.2 months. However, the survival advantage in heavily
pre-treated patients (with three or more previous treatments) was not
significant.
One case, pre-treated with more lines of chemotherapy, with
renal failure after
intraperitoneal cisplatin was followed by death.
None of the patients had bowel sub-occlusions and we recorded a lower
incidence of local toxicity, such as cellulite, with IPC (two out of 33
cases). Two patients thereafter refused IPC due to abdominal pain.
CONCLUSION:
Our
findings confirm that IPC is an effective approach compared to systemic
chemotherapy for advanced ovarian cancer, even in pre-treated patients,
including platinum-resistant cases.
The survival benefit appears to be
confined to non-heavily treated patients. Overall, direct
intraperitoneal drug injection (without permanent devices) appears to be
feasible, safe and possibly advantageous.
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