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The role of intraperitoneal chemotherapy in epithelial ovarian cancer.

Intraperitoneal chemotherapy for the treatment of patients with epithelial ovarian cancer is theoretically an attractive approach taking into account the biology of the disease, the physiologic and anatomic characteristics of the peritoneal cavity, and the pharmacologic advantage of several anticancer agents when administered intraperitoneally compared to intravenously. In patients with advanced disease it can be used either as initial chemotherapy, for consolidation, or as salvage treatment. However, in all clinical settings only those with no gross residual disease or those with macroscopically very small volume residual disease (tumor nodules </=0.5-1 cm in maximum diameter) are suitable for this approach. Intraperitoneal chemotherapy is unlikely to be beneficial in more bulkier disease since drug penetration into larger tumor nodules is limited. Available trial data are summarized. Randomized trials in first-line suggest a superiority of intraperitoneal over intravenous chemotherapy, at least for cisplatin. However, further well designed randomized studies are necessary to assess and confirm whether intraperitoneal chemotherapy is superior over the new standard, ie, intravenous paclitaxel combined with intravenous cisplatin or carboplatin. Although the application of intraperitoneal chemotherapy as salvage treatment or for consolidation is theoretically attractive and some indirect indications of its effectiveness are present, in the absence of randomized studies its routine use cannot be recommended as yet and should be restricted to research settings.