Is There a Role for Intraperitoneal Chemotherapy, Including HIPEC, in the Management of Ovarian Cancer?
Ce dossier fait le point sur les avancées en matière de traitement des cancers gynécologiques
Intraperitoneal Chemotherapy : Because of the predominant intraperitoneal (IP) spread of epithelial ovarian cancer (OC), IP chemotherapy has been investigated for more than three decades, but it is not widely adopted for several reasons. It is well known that retroperitoneal disease and, with better imaging extra-abdominal disease, is present in the majority of patients with advanced OC. In addition, adhesion formation after debulking surgery prevents the equal distribution of drugs administered intraperitoneally. Furthermore, the older trials were underpowered with fewer than 200 patients enrolled, and they used different experimental arms; in some trials, other drugs were added and different dosages were given compared with those in the control arms.1-4 The Gynecologic Oncology Group (GOG) 104 study5 used an outdated control arm with intravenous (IV) cisplatin and IV cyclophosphamide and was rendered statistically significant only after expanding recruitment beyond the originally planned number of patients. The GOG-114 (A Phase III Randomized Study of Intravenous Cisplatin and Cyclophosphamide Versus Intravenous Cisplatin and Taxol Versus High Dose Intravenous Carboplatin followed by Intravenous Taxol and Intraperitoneal Cisplatin in Patients with Optimal Stage III Epithelial Ovarian Carcinoma-Intergroup) study6 was negative for overall survival and the IP chemotherapy was so toxic that the authors concluded that “the experimental (IP) arm was not recommended for routine use.”