Intraperitoneal chemotherapy with mitoxanthrone in ovarian cancer

Ovarian carcinoma remains confined to the peritoneal cavity for the greater part of its natural history, so intraperitoneal (i.p.) administration of chemotherapy could result in greater total drug exposure of the tumor and minimize systemic antiblastic drug side effects. The aim of this study was to evaluate the therapeutic efficacy and toxic effects of intraperitoneal mitoxanthrone in patients affected by ovarian carcinoma with macroscopic absence of disease or minimal residual disease.

Ten patients were enrolled (stage II and III) who had been previously treated with neoadjuvant systemic chemotherapy (CDDP or CBDCA + CTX) and radical surgery resulting in macroscopic absence of disease or minimal residual disease (< 1 cm). Mitoxanthrone (25 mg/m2) was instilled in 2 liters of normal saline every four weeks for 2-4 cycles.

A total of 26 courses was administered; two patients discontinued i.p. therapy, one for chemoperitonitis and another for bowel perforation requiring catheter removal. Of the 10 patients receiving i.p. chemotherapy, 7 are alive at 5 years from radical surgery, and 3 had relapses at 13, 14 and 57 months, respectively, from radical surgery.

Intraperitoneal mitoxanthrone appears to be an effective second-line therapy in ovarian cancer; it is well tolerated as far as toxic effects are concerned, allowing cost reduction and improved patient compliance. For those cases requiring a limited number of peritoneal accesses traditional percutaneous systems have a more favorable cost/benefit ratio.