[Controversies regarding intraperitoneal chemotherapy for advanced ovarian cancer]

Ovarian cancer is unique among solid tumors in its propensity to remain localized in the peritoneal cavity for much of its natural history. There is now a growing body of clinical data demonstrating a survival advantage for patients with advanced stages of ovarian cancer treated by intraperitoneal (i.p.) chemotherapy compared with standard intravenous (i.v.) treatment route. Cytotoxic agents administered directly into the peritoneal cavity, however, have limited potential for penetrating bulky tumor masses. On the basis of the results of three randomized, phase III clinical trials, i.p. chemotherapy has now been shown to be superior to standard i.v. chemotherapy in the primary setting of chemotherapeutic management of advanced epithelial ovarian cancer, with small residual volume after surgery. Despite the fact that i.p. chemotherapy has been shown to determine an improvement in survival, many investigators feel that the formidable toxicity, complexity, and quality of life alterations associated with i.p. therapy make it mandatory that it should be compared prospectively to a less toxic and more convenient regimen of i.v. carboplatin/paclitaxel. The barriers to implementing this treatment into clinical practice appear to be toxicity concerns, and a lack of technical expertise with the peritoneal infusion devices. It is critically important to state that a large body of exiting data revels this is a management approach that can be administered safely, but not in routine oncology practice, outside the setting of a clinical trial or tertiary medical center.