Patterns of recurrence in advanced epithelial ovarian, fallopian tube, and peritoneal cancers treated with intraperitoneal chemotherapy.

Abstract

5072 Background: GOG 1721 established the role of intraperitoneal (IP) chemotherapy in patients with optimally debulked ovarian, fallopian tube and peritoneal cancers. Despite this advance, informational gaps exist, namely the patterns of relapse. This study examines the distribution, timing, and outcomes of recurrence after optimal cytoreduction and adjuvant IP chemotherapy. Methods: All patients diagnosed with ovarian, fallopian tube, or peritoneal cancer between 2004-09 who underwent optimal debulking surgery and received adjuvant intravenous (IV) & IP chemotherapy with paclitaxel and a platinum-based agent were eligible. Age, performance status, tumor origin, stage, and grade were recorded. First recurrences were identified using CA125 values, radiographic studies, operative notes, and pathology reports. Site of recurrence was classified as intraperitoneal, retroperitoneal, or distant. Kaplan-Meier estimates and Cox multivariate regression modeling were used to assess the associations between disease distribution and progression-free survival (PFS) and overall survival (OS). Results: 143 patients underwent optimal debulking surgery and placement of an IP catheter. The majority had Stage III (86%) and serous histology (77%). 84 (58.7%) patients were treated with IV/IP paclitaxel/cisplatin per GOG-172, 59 (41.3%) with IV/IP paclitaxel/carboplatin. 72% (104) completed 6 cycles while 11.9% (17) received ≤ 2 cycles of IV/IP chemotherapy. There were 9 IP catheter-related infections (6.3%). 90 (62.9%) patients had a recurrence. Median PFS was 21.5 months. Primary peritoneal cancers demonstrated worse PFS (p < 0.02) and OS (p < 0.03) relative to ovary and fallopian tube origins. 69 (76.7%) of recurrences were intraperitoneal. Site of recurrence did not impact OS, however, patients who recurred in multiples sites had significantly worse overall survival (p < 0.001). Conclusions: A quarter of patients treated with IP chemotherapy have a first recurrence outside the peritoneal cavity. Though site of recurrence did not affect OS those with multi-focal recurrence have a poor survival. Improved therapeutic options are needed for this population.