Optimally debulked stage III ovarian cancer: intraperitoneal or intravenous chemotherapy?

The optimal management of women with optimally debulked stage III ovarian cancer is contentious. There are in particular widely differing views regarding the role of intraperitoneal chemotherapy, and this has been debated widely. Being on the negative side in the debate, I will provide compelling reasons why systemic chemotherapy should remain the standard of care but argue that dose-dense weekly paclitaxel rather than the 3 weekly schedules should be adopted based on the results of the Japanese Gynecologic Oncology Group study. The pharmacokinetics of intraperitoneal paclitaxel suggests that intraperitoneal paclitaxel at day 8 with intravenous paclitaxel at day 1 is only a more complicated way of delivering dose-dense paclitaxel.