Use of intraperitoneal chemotherapy for treatment of ovarian cancer

Second line chemotherapeutic therapy following failure with Cis-platinum combined regimens for treatment of cancer of the ovary is discouraging. Similarly, results with the use of Cis-platinum combined regimens for patients with less than well debulked primary surgery are also discouraging. In an attempt to improve these results, a series of 57 patients were subjected to high dose Cis-platinum and AraC given intraperitoneally. 44 of these patients were those that had been subjected to a second look procedure after 8-12 months of Cis-platinum therapy and were found to have residual disease in the form of positive cytology or microscopic disease up to nodules of 1.5 cm in diameter. 13 of the patients, because of less than well-debulked surgical procedures, were also accepted for therapy. In all patients, a subcutaneously implanted catheter was introduced into the patient and the tube was tunneled through the subcutaneous tissue into the peritoneal cavity. Cis-platinum and AraC were introduced into the peritoneal cavity through this cutaneous line. Concurrently, with the administration of the intraperitoneal therapy, Sodium Thiosulfate was given intravenously for systemic protection from Cis-platinum toxicity. Treatments were given every three to four weeks and the number of courses varied from 3 to 8 for a total of 184 injections for the entire group. In seven of these patients distribution studies were carried out using radioactive sulfur colloids which were injected peritoneally prior to the first treatment and preceding each subsequent treatment in order to evaluate the anticipated distribution of the chemotherapeutic agents. Only 4 of the 44 patients in group 1 and 3 of the 13 patients in group 2 are alive without evidence of disease at the present time. The low success rate is believed due to the poor distribution of the chemotherapeutic agents after the first two or three injections. In most of the patients, by the third or fourth treatment, they were found to have developed loculated restricted areas with minimal distribution of the agents. This was also demonstrated by the distribution studies carried out with the sulfur colloid.