The use of intraperitoneal chemotherapy for advanced ovarian cancer - The experience of a tertiary referral centre

Leon Foster; Christina Girgis; Adrienne Kirby; Paul Harnett; Alison Brand

doi:10.1111/ajo.13767

The use of intraperitoneal chemotherapy for advanced ovarian cancer - The experience of a tertiary referral centre

Aust N Z J Obstet Gynaecol. 2023 Nov 22. doi: 10.1111/ajo.13767. Online ahead of print.

Authors

Leon Foster^{1

2}, Christina Girgis³, Adrienne Kirby⁴, Paul Harnett^{3

5}, Alison Brand^{1

5}

Affiliations

¹ Department of Gynaecology Oncology, Westmead Hospital, Sydney, New South Wales, Australia.
² The University of New South Wales, Sydney, New South Wales, Australia.
³ Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.
⁴ Clinical Trials Centre, National Health and Medical Research Council, University of Sydney, Sydney, New South Wales, Australia.
⁵ School of Medicine, University of Sydney, Sydney, New South Wales, Australia.

PMID: 37994114
DOI: 10.1111/ajo.13767

Abstract

Background: Platinum-based chemotherapy is the backbone of the medical management of ovarian cancer. The dose, route and timing of treatment are ongoing areas of debate. Intraperitoneal (IP) chemotherapy is an alternative delivery method treatment to the conventional intravenous (IV) route for patients with epithelial ovarian cancer, with efficacy supported by Level 1 evidence.

Aims: To compare the outcomes and feasibility of IP to IV delivery of platinum-based chemotherapy in patients with advanced epithelial ovarian cancer.

Materials and methods: In a single institution, patients receiving adjuvant chemotherapy (IP and IV) for Stages III and IV epithelial ovarian cancer over the period January 2006-December 2018 were identified through a prospectively maintained database. All patients with an IP port inserted were included. A control group of patients treated with IV chemotherapy was created using criteria identified during the study and in the randomised trials that tested IP chemotherapy. Assessments were made for relapse-free survival (RFS) and overall survival (OS) for each cohort.

Results: A total of 639 patients received adjuvant chemotherapy (73 IP and 566 IV) during the study period. Both the IP group and matched IV control group (65 patients) had a median RFS of 26 months. The median OS in the IP group was 63.9 months, and in the IV group was 57.2 months. At ten years, a significantly higher proportion of patients were alive in the IP group cohort (16% vs 3%, relative risk 5.5, 95% CI 1.29-24, P = 0.012). IP chemotherapy was well tolerated by our cohort. In the IP group, 73% had four or more IP cycles and 99% received six or more cycles of chemotherapy.

Conclusions: Our cohort had a high rate of completion of IP chemotherapy with excellent rates of completion of six cycles of any treatment. The RFS and OS in the IP chemotherapy group were comparable to each other and reflected those in the published literature. A significantly higher proportion of patients in the IP cohort were alive at ten years than in the IV cohort.

Keywords: chemotherapy; intraperitoneal chemotherapy; ovarian cancer.