SpringerLink
Log in

Neoadjuvant intraperitoneal chemotherapy with paclitaxel for the radical surgical treatment of peritoneal carcinomatosis in ovarian cancer: a prospective pilot study

  • Short Communication
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The admitted benefits of intraperitoneal chemotherapy during postoperative administration for the treatment of peritoneal carcinomatosis from ovarian origin are limited by their associated morbidity and restricted diffusion by the presence of multiple intra-abdominal adherences. The purpose of the study was to evaluate the security, effectiveness, and cytoreduction optimization of intraperitoneal paclitaxel administration previously to radical surgery/peritonectomy/HIPEC (hyperthermic intraoperative intraperitoneal chemotherapy) either in monotherapy or combined with intravenous carboplatin.

Methods

Prospective pilot study of 10 patients with ovarian peritoneal carcinomatosis in stage IIIc-FIGO without previous treatment. After staging of the diseases by laparoscopy, five patients received paclitaxel by weekly intraperitoneal administration (60 mg/m2, 10 cycles), and other five patients additionally received intravenous carboplatin every 21 days (AUC 6, 4 cycles). Subsequently radical surgery/peritonectomy with HIPEC was performed.

Results

The presence of moderate abdominal pain was the most common (70%) side effect associated with neoadjuvant paclitaxel intraperitoneal administration. The intravenous carboplatin administration was not associated with significant increase in adverse effects. It boosted intraperitoneal paclitaxel-associated antitumoral activity with a high average decrease in Index Cancer Peritoneal (21.2 vs. 14.4, P = 0.066) and CA 125(1,053 vs. 346, P = 0.043). All the patients who received combined neoadjuvant chemotherapy obtained R0 cytoreduction. Five-year overall survival was 62%.

Conclusions

The intraperitoneal paclitaxel weekly administration combined with intravenous carboplatin administration prior to radical surgery/peritonectomy with HIPEC is a safe and effective option in the treatment of ovarian peritoneal carcinomatosis. This study shows the possibility to investigate other forms of intraperitoneal chemotherapy and their combinations thoroughly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  2. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221:29–42

    Article  PubMed  CAS  Google Scholar 

  3. Sugarbaker PH (2009) Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer. Curr Opin Obstet Gynecol 21:15–24

    Article  PubMed  Google Scholar 

  4. Bijelic L, Jonson A, Sugarbaker PH (2007) Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol 18:1943–1950

    Article  PubMed  CAS  Google Scholar 

  5. Elias D, Delperro JR, Sideris L, Benhamou E, Pocard M, Baton O, Giovannini M, Lasser P (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol 11:518–521

    Article  PubMed  Google Scholar 

  6. Alberts DS, Liu PY, Hannigan EV, O′Toole R, Williams SD, Young JA, Franklin EW, Clarke-Pearson DL, Malviya VK, DuBeshter B (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335:1950–1955

    Article  PubMed  CAS  Google Scholar 

  7. Markman M, Bundy BN, Alberts DS, Fowler JM, Clark-Pearson DL, Carson LF, Wadler S, Sickel J (2001) Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the gynecologic oncology group, Southwestern oncology group, and Eastern cooperative oncology group. J Clin Oncol 19:1001–1007

    PubMed  CAS  Google Scholar 

  8. Armstrong DK, Bundy B, Wenzel L, Huang HQ, Baergen R, Lele S, Copeland LJ, Walker JL, Burger RA, Group Gynecologic Oncology (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43

    Article  PubMed  CAS  Google Scholar 

  9. Tentes AA, Tripsiannis G, Markakidis SK, Karanikiotis CN, Tzegas G, Georgiadis G, Avgidou K (2003) Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol 29:69–73

    Article  PubMed  Google Scholar 

  10. Muñoz-Casares FC, Rufián S, Rubio MJ, Lizárraga E, Díaz-Iglesias C, Aranda E, Ciria R, Muntané J, Barrios P, Torres-Melero J, González-Moreno S, González-Bayón L, Camps B, Bretcha P, Farré J, Ortega-Pérez G, Gómez-Portilla A (2007) Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals. Clin Transl Oncol 9:652–662

    Article  PubMed  Google Scholar 

  11. Rufián S, Muñoz-Casares FC, Briceño J, Díaz CJ, Rubio MJ, Ortega R, Ciria R, Morillo M, Aranda E, Muntané J, Pera C (2006) Radical surgery-peritonectomy and intraoperative intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis in recurrent o primary ovarian cancer. J Surg Oncol 94:316–324

    Article  PubMed  Google Scholar 

  12. National Cancer Institute (2006). Cancer therapy evaluation program, common terminology criteria for adverse events v3.0 (CTCAE). Available: http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcaev3.pdf. Published August 9, 2006

  13. Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259

    Article  PubMed  Google Scholar 

  14. Ryu KS, Kim JH, Ko HS, Kim JW, Ahn WS, Park YG, Kim SG, Lee JM (2004) Effects of intraperitoneal hyperthermic chemotherapybin ovarian cancer. Gynecol Oncol 94:325–332

    Article  PubMed  CAS  Google Scholar 

  15. Muñoz-Casares FC, Rufián S, Rubio MJ, Díaz CJ, Díaz R, Casado A, Arjona A, Muñoz-Villanueva MC, Muntané J (2009) The role of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal carcinomatosis in recurrent ovarian cancer. Clin Transl Oncol 11:753–759

    Article  PubMed  Google Scholar 

  16. Weinberg LE, Rodriguez G, Hurteau JA (2010) The role of neoadjuvant chemotherapy in treating advanced epithelial ovarian cancer. J Surg Oncol 101:334–343

    Article  PubMed  CAS  Google Scholar 

  17. Francis P, Rowinsky E, Schneider J, Hakes T, Hoskins W, Markman M (1995) Phase I feasibility and pharmacologic study of weekly intraperitoneal paclitaxel: a gynecologic oncology group pilot study. J Clin Oncol 13:2961–2967

    PubMed  CAS  Google Scholar 

  18. de Bree E, Rosing H, Michalakis J, Romanos J, Relakis K, Theodoropoulos TA, Beijnen JH, Georgoulias V, Tsiftsis DD (2006) Intraperitoneal chemotherapy with taxanes for ovarian cancer with peritoneal dissemination. Eur J Surg Oncol 32:666–670

    Article  PubMed  Google Scholar 

  19. De Iaco P, Musto A, Orazi L, Zamagni C, Rosati M, Allegri V, Cacciari M, Al-Nahhas A, Rubello D, Venturoli S, Fanti S (2010) FDG-PET/CT in advanced ovarian cancer staging: value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy. Eur J Radiol [Epud ahead of print]

  20. Yonemura Y, Bandou E, Sawa T, Yoshimitsu Y, Endou Y, Sasaki T, Sugarbaker PH (2006) Neoadjuvant treatment of gastric cancer with peritoneal dissemination. Eur J Surg Oncol 32:661–665

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank the Andalusian Cancerology Society (SAC) for trusting and supporting the basic idea of this research study.

Author information

Authors and Affiliations

  1. Department of General Surgery. Surgical Oncology Unit, Reina Sofía University Hospital, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain

    Francisco C. Muñoz-Casares, Sebastián Rufián, Álvaro Arjona-Sánchez, Rafael Díaz, Ángela Casado, Álvaro Naranjo & Carlos J. Díaz-Iglesias

  2. Department of Oncology, Reina Sofía University Hospital, Córdoba, Spain

    María J. Rubio & Enrique Aranda

  3. Department of Pathology, Reina Sofía University Hospital, Córdoba, Spain

    Rosa Ortega

  4. Research Unit, Reina Sofia University Hospital, Córdoba, Spain

    María C. Muñoz-Villanueva & Jordi Muntané

Authors
  1. Francisco C. Muñoz-Casares
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastián Rufián
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Álvaro Arjona-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. María J. Rubio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rafael Díaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ángela Casado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Álvaro Naranjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlos J. Díaz-Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosa Ortega
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. María C. Muñoz-Villanueva
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jordi Muntané
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Enrique Aranda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francisco C. Muñoz-Casares.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muñoz-Casares, F.C., Rufián, S., Arjona-Sánchez, Á. et al. Neoadjuvant intraperitoneal chemotherapy with paclitaxel for the radical surgical treatment of peritoneal carcinomatosis in ovarian cancer: a prospective pilot study. Cancer Chemother Pharmacol 68, 267–274 (2011). https://doi.org/10.1007/s00280-011-1646-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-011-1646-4

Keywords

Search

Navigation