A Modified Intraperitoneal Chemotherapy Regimen for Ovarian Cancer: Technique and Treatment Outcomes

Abstract

This study aimed to investigate treatment outcomes concerning three institutional modifications to intraperitoneal (IP) chemotherapy for patients with ovarian cancer. The medical records of 27 patients treated with IP chemotherapy were retrospectively reviewed. All patients had three IP chemotherapy institutional modifications; modified Gynecologic Oncology Group 172 regimen was used for the chemotherapy regimen. With institutional modifications, 63.0% (17/27) completed all six cycles of IP chemotherapy. Of the 17 and 10 patients with primary and recurrent ovarian cancer, respectively, 55.6% (15/27) underwent left colonic surgery, including low anterior resection. In patients with primary ovarian cancer, the IP chemotherapy completion rate was 76.5% (13/17). In patients with and without left colonic surgery, the IP chemotherapy completion rates were 53.3% (8/15) and 75.0% (9/12), respectively. No complications related to left colonic surgery during IP chemotherapy were identified. The most frequent grade 3-4 toxicities were gastrointestinal toxicities (33.3%) and neutropenia (29.6%). The median progression-free survival was 19.5 months in all patients and 25.2 months in patients with primary ovarian cancer. Three institutional modifications to IP chemotherapy increased the completion rate for planned IP chemotherapy, even after left colonic surgery. Further studies involving a larger study cohort are required to confirm survival outcomes using these modifications.

Keywords: chemotherapy; intraperitoneal; ovarian cancer; survival; toxicity.

Figure 1

The modified IP catheter insertion technique: (A) A 5 cm length incision for the IP port was made at the mid-clavicular line on the lower rib, and the IP port chamber was outlined. (B) Subcutaneous tissue below the IP port chamber was partially removed for easy insertion of the needle into the IP port. (C) The catheter was inserted in a neutral position of the abdominal wall at the time of total closure of the wound. Retraction of the abdominal wall upward was avoided to prevent tortuous placement of the IP port line. While the guidewire was inserted into the fascia with the right hand, the left hand was used to palpate the optimal placement of the guidewire. The guidewire penetrated the fascia, muscle, and peritoneum subsequentially, while maintaining a natural position of the closed abdomen after passing 10–15 cm into the fascia.

Figure 2

A Kaplan–Meier curve for progression-free survival and overall survival: (A) A Kaplan–Meier curve of progression-free survival in all patients’ post-IP chemotherapy. (B) A Kaplan–Meier curve of progression-free survival in patients with primary ovarian cancer post-IP chemotherapy. (C) A Kaplan–Meier curve of overall survival in all patients’ post-IP chemotherapy.

Figure 3

Placement of the IP port: (A) Prior to modification of the IP port insertion, the subcutaneous tissue on the IP port was not surgically reduced, and the IP port was inserted while upward retraction of abdominal wall was obtained using a Richardson retractor. Needling of the IP port was challenging because the subcutaneous tissue and tortuous insertion of the IP port line increased the risk of IP port obstruction. (B) After modification of the IP port insertion, the subcutaneous tissue on the IP port was surgically reduced for easy palpation and efficient needling of the IP port. The IP port line was straight onto the fascia and penetrated smoothly into the peritoneal cavity.