Nicoletto Maria Ornella, Dalla Palma Maurizia, Donach Martin E, Gusella Milena, Cappetta Alessandro, Shams Malihe, Marchet Aberto, Nardin Margherita, Pintacuda Giovanna, Di Maggio Antonio, Marchesi Maddalena, Carli Paolo, Fiduccia Pasquale, Artioli Grazia, Nitti Donato
Oncologia Medica 1, Istituto Oncologico Veneto/IRCCS, Padua, Italy.
Tumori. 2010 Nov-Dec;96(6):918-25.
To assess feasibility and toxicity of intraperitoneal administration of cisplatin and paclitaxel, followed by intravenous chemotherapy in pretreated patients with suboptimal ovarian cancer (residuum >1 cm) or primary peritoneal tumor, and suffering from ascites and/or intestinal obstruction.
Fourteen relapsed ovarian cancer patients, 5 of whom were platinum sensitive (platinum-free interval >6 mo), 7 platinum-resistant (platinum-free interval <6 mo), and 2 platinum-refractory, received one cycle of intraperitoneal cisplatin, 100 mg/m2 on day 1, and two cycles of intraperitoneal paclitaxel, 120 mg/m2 on days 8 and 14. Intravenous chemotherapy was administrated 4 weeks following the last intraperitoneal paclitaxel instillation. Blood and peritoneal fluid samples were harvested at 0, 1, 4 and 24 h after ending paclitaxel delivery to guarantee proper tumor exposure and patient safety.
Intraperitoneal cisplatin determined 6 cases of vomiting grade 1-2 (40% of the morbidity). Intraperitoneal paclitaxel was associated with 6 events of grade 1-2 abdominal pain; the only grade 4 toxicity was one case of neutropenia and one of mucositis. Ascites decreased in 11 patients: the median time to first need for paracentesis was 5 months, compared to a median baseline paracentesis of 4 weeks. Three intestinal normalizations were obtained. The median overall survival was 10 months for our cohort of patients. Intraperitoneal paclitaxel clearance was significantly higher in patients with suboptimal tumor and symptomatic disease than in patients with smaller residual masses and without ascites (P = 0.004).
Intraperitoneal treatment was feasible, and enhanced response to the following intravenous chemotherapy was seen in these patients.
评估顺铂和紫杉醇腹腔内给药，随后对先前接受过治疗、卵巢癌（残留灶>1 cm）或原发性腹膜肿瘤疗效欠佳、伴有腹水和/或肠梗阻的患者进行静脉化疗的可行性和毒性。
14例复发性卵巢癌患者，其中5例对铂类敏感（无铂间期>6个月），7例铂类耐药（无铂间期<6个月），2例铂类难治性患者，接受一个周期的腹腔内顺铂治疗（第1天100 mg/m²），以及两个周期的腹腔内紫杉醇治疗（第8天和第14天120 mg/m²）。在最后一次腹腔内紫杉醇灌注后4周进行静脉化疗。在紫杉醇输注结束后0、1、4和24小时采集血液和腹腔液样本，以确保肿瘤充分暴露和患者安全。
腹腔内顺铂导致6例1-2级呕吐（发病率40%）。腹腔内紫杉醇与6例1-2级腹痛事件相关；唯一的4级毒性是1例中性粒细胞减少和1例粘膜炎。11例患者腹水减少：首次需要腹腔穿刺的中位时间为5个月，而基线腹腔穿刺的中位时间为4周。3例患者肠道梗阻缓解。我们这组患者的中位总生存期为10个月。肿瘤疗效欠佳且有症状的患者腹腔内紫杉醇清除率显著高于残留肿块较小且无腹水的患者（P = 0.004）。
腹腔内治疗是可行的，并且这些患者对随后进行的静脉化疗反应增强。
