Management of peritoneal surface component of ovarian cancer

Primary surgery followed by systemic platinum-based chemotherapy is the cornerstone of management for ovarian cancer. However, the majority of patients have an advanced disease (stage III/IV) at the time of diagnosis rendering the optimal primary cytoreduction feasible in only a small percentage of cases. A large tumor bulk limits the success of subsequent antiblastic therapy. There are two alternatives to overcome this unfavorable situation: (1) employment of ultra-radical interventions such as peritonectomy procedures, to increase the optimal cytoreduction rate; or (2) neoadjuvant chemotherapy. Whether such strategies would have an influence on the final outcome of patients is an issue to be defined in further prospective randomized studies. For second-line therapies no consensus regarding treatment has emerged. When previous effective drug combinations fail, there is virtually no chance of inducing a significant response with second-line treatment. The combination of secondary CRS and intraperitoneal hyperthermic perfusion constitutes a feasible and potential option for this subset of patients based on phase II studies. A randomized trial will be conducted to test the effectiveness of this strategy in patients with cisplatin-resistant disease. The indication for second-line treatment is macroscopic residual or relapse within 6 months after the completion of first line chemotherapy.