Introduction Intraperitoneal Chemotherapy for Advanced Ovarian Cancer Finally a Standard of Care

Key Words Intraperitoneal chemotherapy, ovarian cancer, IP cisplatin, IP paclitaxel, cancer survival Epithelial ovarian cancer is the fourth leading cause of cancer death in women in the United States, with an estimated incidence of 20,180 and 15,310 deaths in 2006 (1). According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, the five-year relative survival rates for women with localized ovarian cancer is 93.6 , whereas for those with distant...

Consolidation

Despite adequate front-line therapy, it is well established that even with a complete pathologic response confirmed at second-look laparotomy, 60 of patients will recur within 10 yr (39). This emphasizes the need for methods of consolidating complete initial responses. There have been no randomized studies investigating the role of HIPEC as consolidation therapy at second-look laparotomy, but some work has been reported in this setting. de Bree (29) was the first to report the use of HIPEC at...

Implications Of The Current Ip Chemotherapy Data For The Primary Chemotherapeutic Management Of Smallvolume Residual

The data from these three randomized phase III trials have now firmly established a new standard of care in the primary chemotherapeutic management of small-volume residual advanced ovarian cancer (16,59,62). Collectively, they indicate that patients treated with cisplatin by the IP route experience a 20 -30 reduction in the risk of death compared with intravenous drug delivery. These results are similar to those previously documented when paclitaxel was substituted for cyclophosphamide in the...

Future Directions In The Use Of Ip Chemotherapy In The Management Of Ovarian Cancer

The results of three large prospective randomized phase III trials have now established IP chemotherapy as the standard of care in the primary chemothe-rapeutic management of small-volume residual advanced ovarian cancer (16,59,62). Much research remains to be done in this arena, including focusing major efforts to improve methods of drug delivery (discussed in Chapter 5), exploring novel antineoplastic agents administered regionally, and developing innovative strategies to enhance drug...

Scott Richard md and Robert P Edwards md

Although striking evidence exists that argues for the usefulness of hyperthermic intra-peritoneal chemotherapy (HIPEC) for the treatment of peritoneal carcinomatosis (PC), many aspects of this therapy have yet to be standardized. As interest in this modality increases, there are several avenues of research to be explored. How important is the cyto-reductive effort, the temperature elevation increment, and the length of time for the hyper-thermic perfusion We review what is known and what may be...

Techniques For Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy

Careful preoperative planning is needed to confirm relatively normal organ function and minimize operative risks (10). If extensive pelvic dissection is anticipated, cystoscopy and temporary bilateral ureteral catheters will be placed immediately before laparotomy. This speeds up surgery by decreasing the need for mobilization, and also decreases possible tumor seeding and injury to ureters and facilitates bladder resection or repair. CRS requires mobilization and visualization of every...

Mechanisms of Hyperthermia Induced Cancer Cell Death

By the early 1980s, basic science research had begun to elucidate mechanisms of hyperthermia-induced cell death. Cavaliere et al., (104) had confirmed the tumoricidal effects of heat through biochemical studies, Dickson et al., (92) had extrapolated the first thermal-dose time curves for heat killing, Giovanella (105) had demonstrated tumor cell thermosensitivity, and Dewey et al., (106) reported that heat prevented repair of radiation injury. In the 1980s and 1990s, relevant observations...

Historical Perspective

In 1978, Dedrick proposed the potential benefit of IP administration of chemotherapy for peritoneal carcinomatosis caused by ovarian cancer 2 . Since this report, attempts have been made to infuse chemotherapy into the peritoneal cavity for the treatment of ovarian cancer. The report recommended that the chemotherapy agent be administered in large volumes of fluid for adequate distribution, to ensure contact of chemotherapy agent with all tumors on peritoneal surfaces. The standard infusion...

Appendiceal Cancer Including Pseudomyxoma Peritonei

Primary appendiceal cancer is rare, and is divided into several major categories, including carcinoid, mucinous neoplasms, and adenocarcinoma, as well as rarer types such as adenocarcinoid, goblet cell, and signet cell type. Altogether, they account for 0.5 of all GI malignancies 12-14 . The most common metastatic location for these tumors is to spread to the peritoneal cavity, causing PC. Historically, this was considered a fatal situation. The 5-yr survival rate before using CRS HIPEC was...

Hyperthermic Intraperitoneal Chemotherapy

Hipec Closed Technique

Even the most extensive surgery for PC does not succeed in removal of every cancer cell. Microscopic foci will always remain. It is also important to realize that during surgery in PC a large number of free cancer cells are present, and they find an easy seeding bed in all the fresh wound surfaces. Additional treatment is needed to prevent early recurrence from these residual tumor cells 9 . During HIPEC, the abdomen is used as a basin, perfused with a drug containing solution, at a chosen...

Phase Ii Trial Experience With Ip Cisplatin In Ovarian Cancer

Predictably, based on its central role in the management of ovarian cancer, much of the initial phase II trial effort both single-agent and combination chemotherapy regimens in the malignancy focused on cisplatin 30-37 . Further, with few exceptions, the early phase II IP trials in ovarian cancer were directed toward treating women with this strategy as a second-line treatment approach. Exploration of the activity of IP cisplatin in this particular clinical setting permitted a most interesting,...

Placement At The Time Of Open Laparotomy

Port Placement For Chemotherapy

The catheter is tunneled above the fascia from an implantable port location, at the midclavicular line on the inferior costal margin, to a peritoneal entrance point approximately 6 cm lateral to the umbilicus. A tunneling device, which is packaged with the catheter, is ideal for this part of the procedure because it leaves a dissection tract only the width of the catheter. The catheter should be placed over the ascending or descending colon and progress toward the pelvis, depending on where the...