Hamilton Chad A, Berek Jonathan S
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Center, Stanford University School of Medicine, Stanford, California 94305, USA.
Curr Opin Oncol. 2006 Sep;18(5):507-15. doi: 10.1097/01.cco.0000239892.21161.18.
Intraperitoneal chemotherapy for ovarian cancer is based on sound pharmacological principles and is technically feasible. There is mounting evidence, bolstered by a recent randomized trial, that in certain patients, this route of delivery may be superior to traditional intravenous chemotherapy. This review explores the background and pharmacokinetic principles of intraperitoneal chemotherapy, the recent evidence supporting an intraperitoneal approach, and some of the logistical and technical challenges involved.
Intraperitoneal chemotherapy has been evaluated in several settings. Most phase I and II data came from second-line treatment of ovarian cancer, and there have been a few series, including one recent phase III trial, exploring intraperitoneal consolidation. The greatest impact among recent studies will be from a large, intergroup phase III trial evaluating intraperitoneal therapy in the front-line setting. This study will probably change the dialogue of standard treatment for optimally cytoreduced, advanced epithelial ovarian cancer.
Based on recent findings, intraperitoneal chemotherapy should be considered for the front-line treatment of women with minimal residual advanced ovarian cancer. Efforts should continue to facilitate the integration of intraperitoneal treatment into mainstream practice, and future trials should be designed to address lingering controversy surrounding this route of treatment.
卵巢癌腹腔内化疗基于合理的药理学原理，技术上可行。最近一项随机试验提供了越来越多的证据，表明在某些患者中，这种给药途径可能优于传统的静脉化疗。本综述探讨了腹腔内化疗的背景和药代动力学原理、支持腹腔内化疗方法的最新证据以及所涉及的一些后勤和技术挑战。
腹腔内化疗已在多种情况下进行评估。大多数I期和II期数据来自卵巢癌的二线治疗，并且有一些系列研究，包括一项最近的III期试验，探索腹腔内巩固治疗。最近研究中影响最大的将是一项大型的多组III期试验，该试验在一线治疗中评估腹腔内治疗。这项研究可能会改变关于最佳细胞减灭的晚期上皮性卵巢癌标准治疗的讨论。
基于最近的发现，对于残留最少的晚期卵巢癌女性，应考虑将腹腔内化疗作为一线治疗。应继续努力促进将腹腔内治疗纳入主流实践，并且未来的试验应设计用于解决围绕这种治疗途径的持续争议。
