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Indian Journal of Cancer, Vol. 47, No. 2, April-June, 2010, pp. 225-226 Letter To Editor Feasibility of intraperitoneal chemotherapy in advanced epithelial ovarian cancer Maheshwari A, Gupta S1, Prabhash K1, Tongaonkar HB Departments of Surgical and 1 Medical, Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai - 400 012, India Correspondence Address: Dr. Amita Maheshwari, Department of Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai - 400 012, India maheshwariamita@yahoo.com Code Number: cn10055 PMID: 20448394 DOI: 10.4103/0019-509X.63007 Sir, Intraperitoneal chemotherapy (IPCT) has been shown to offer some survival advantage over intravenous chemotherapy (IVC) in optimally cytoreduced epithelial ovarian cancer (EOC) patients as per the results of randomized trials and meta-analyses. [1],[2],[3] However, despite its superiority, IPCT has not gained wide acceptance due to high toxicity rates. We did a prospective evaluation of the feasibility of IPCT in patients with advanced EOC after optimal primary or interval cytoreduction. Eleven patients were accrued from August 2007 till date. Nine patients had interval surgery after NACT (paclitaxel-carboplatin) and two had primary surgery. BardPort ® (9.6 F) with peritoneal catheter was used for instilling IPCT, which was inserted at the time of surgery in all patients. The IPCT protocol was: Paclitaxel 135 mg/m 2 intravenous infusion over 24 h on D1, Cisplatin 100 mg/m 2 in 2 L of normal saline intraperitoneal infusion on D2 and Paclitaxel 60 mg/m 2 in 2L of normal saline intraperitoneal infusion on D8. The mean age was 48.5 years (range, 25-66). The median pretreatment serum CA-125 level was 4011 U/mL. The total number of IPCT cycles planned in 11 patients was 36, of which 30 cycles (85.8%) could be given; reasons for not giving IPCT were related to toxicity in 2# and unrelated in 4#. The D8 chemotherapy (IP paclitaxel) could not be given in 11# (36.7%) and dose reduction by ≥25% was required in 2# (6.7%), due to significant toxicity. Overall, 25 IP # (83.3%) resulted in significant toxicity. Various toxicities (grade 3/4) were: vomiting in 13# (43.3%), abdominal pain in 10# (33.3%), diarrhea in 3# (10%), dyselectrolytemia in 8# (26.7%), neutropenia in 12# (40%), febrile neutropenia in 3# (10%), anemia in 5# (16.7%), thrombocytopenia in 1# (3.3%) and PORT site extravasation of cisplatin in 1# (3.3%). There was no treatment related mortality. Of note, there was a significant incidence of hyponatremia, hypokalemia and hypomagnesemia that required electrolyte repletion for several days. The author′s current practice is to prophylactically administer these electrolytes in the inpatient setting. The toxicity in our study compares with GOG-172 [1] in which only 42% of the patients could complete all planned doses of IPCT. The current analysis shows that IPCT is feasible after primary and interval cytoreductive surgery. However, the currently used protocol resulted in significant toxicity and a significant proportion of patients could not take D8 of IPCT. Intraperitoneal route needs to be explored with better tolerated schedules, doses and agents. References
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