First line immunochemotherapy with cisplatin-based protocol by intraperitoneal and intravenous routes in ovarian cancer: technique and results of 82 cases

Abstract

Objectives: The aim of this study, initiated in 1982, was to determine the feasibility and the interest of a first-line immunochemotherapy delivered by intraperitoneal (i.p.) and intravenous (i.v.) routes combined in ovarian cancer. Study design: Eighty-two naive patients with a common epithelial cancer entered the study from January 1982 to December 1990 (median follow up > 70 months). For i.p. infusion, we used a simple lumbar puncture needle left in situ for < 2 h. The first 18 patients received monthly by i.p. route: Adriamycin (DXR) 40 mg/m 2, Fluorouracil 1000 mg/m 2, Cisplatin (CDDP) 90 mg/m 2, Bleomycin 30 mg — DGZ (extract of vibrio cholerae) 60 mg/m 2. For the remaining 64 patients Aracytin 500 mg/m 2 replaced DXR and the dose of CDDP was more than doubled (200 mg/m 2) thanks to the use of sodium thiosulfate. All 82 patients received Ifosfamid 1300 mg/m 2 intravenously. Results: Local toxicity consisted in one subcutaneous abscess and one bacterial peritonitis out of 1508 abdominal punctures. Stage III turned out to be the most interesting group to evaluate the efficacy of a first-line protocol. In this group 34 out of 47 patients (72.3%) who underwent an initial incomplete surgery were in complete remission (CR) at second-look. Nevertheless, 21 out of the 34 patients in CR relapsed (61.7%) and 14 died (43.2%). Conclusion: These results show the efficacy of our regimen administered i.p., and the safety of the delivery by a simple needle which avoids the complications of the implantable systems. Nevertheless, the usefulness of a systematic second-line chemotherapy (Paclitaxel?), despite a prognosis situation as favorable as a CR at second-look, must be taken into consideration.