|
The Cochrane Collaboration
Cochrane Reviews |
| Explore | New + Updated | Other languages |
|
 |
Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancerJaaback K, Johnson N
Bookmark this:
     more ...
SummaryIntraperitoneal (IP) chemotherapy (chemotherapy administered directly into the peritoneal cavity) for advanced ovarian cancer improves both overall and disease free survivalOvarian cancer commonly spreads through the peritoneal cavity and usually responds to intravenous (IV) chemotherapy. This review compared the effectiveness of this IV chemotherapy to chemotherapy administered directly into the peritoneal cavity (IP). The evidence suggests an improvement in survival if some of the chemotherapy is administered via the intraperitoneal route. The disadvantage is an increase in adverse effects principally relating to the presence of a peritoneal catheter, including pain, catheter blockage, gastrointestinal effects and infection.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 25. 2006 AbstractBackgroundOvarian cancer tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal chemotherapy. Chemotherapy for ovarian cancer is usually given as an intravenous infusion repeatedly over 5 to 8 cycles. Intraperitoneal chemotherapy (IP) is given by infusion of the chemotherapeutic agent directly into the peritoneal cavity. This may increase the anticancer effect with fewer systemic adverse effects in comparison to intravenous therapy. ObjectivesTo determine if adding a component of the chemotherapy regime into the peritoneal cavity affects overall survival, progression free survival, quality of life (QOL) and toxicity for women receiving primary treatment of epithelial ovarian cancer. Search strategyThe authors searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1951 to 16 March 2005), EMBASE (1974 to 16 March 2005), Gynaecological Cancer Review Group Specialised Register, The searches were updated in February 2007. Handsearching and cascade searching of the major gynaecological oncology journals was also carried out. Selection criteriaThe analysis was restricted to randomised controlled trials (RCTs) assessing women with a new diagnosis of primary epithelial ovarian cancer, of any FIGO stage, following primary cytoreductive surgery. Standard intravenous chemotherapy was compared with chemotherapy that included a component of intraperitoneal administration. Data collection and analysisTwo authors conducted data extraction independently. The authors retrieved data on overall and disease free survival as well as adverse events and QOL and then performed a meta-analysis of outcomes, using hazard ratios (HR) for time-to-event variables and relative risks (RR) for dichotomous outcomes. Main resultsEight randomised trials studied 1819 women receiving primary treatment for ovarian cancer. Women were less likely to die if they received an IP component to the chemotherapy HR = 0.80; 95% confidence interval (CI): 0.71 to 0.90) and the disease free interval (HR = 0.79; 95% CI: 0.69 to 0.90) was also significantly prolonged. There may be greater serious toxicity with regard to gastrointestinal effects, pain and fever but less toxicity with the IP than the IV route. Authors' conclusionsThis analysis establishes the benefit of IP chemotherapy. It increases overall survival and progression free survival from advanced ovarian cancer. The results of this meta-analysis provide the most reliable estimates of the relative survival benefits of IP over IV therapy and should be used as part of this decision making process. However, the potential for catheter related complications and toxicity needs to be considered when deciding on the most appropriate treatment for each individual woman. The optimal dose, timing and mechanism of administration cannot be addressed from this meta-analysis. This needs to be addressed in the next phase of clinical trials. |