Does intraperitoneal chemotherapy benefit optimally debulked epithelial ovarian cancer patients after neoadjuvant chemotherapy?

OBJECTIVE

To compare survival of ovarian cancer patients treated with neoadjuvant chemotherapy followed by intraperitoneal (IP) versus intravenous (IV) chemotherapy after optimal interval debulking.

METHODS

Optimally debulked patients after neoadjuvant IV platinum paclitaxel based chemotherapy followed by postoperative IP chemotherapy were reviewed. A similar cohort of patients treated postoperatively with IV platinum paclitaxel based chemotherapy was chosen as control. Patient and disease-related demographics were abstracted from electronic hospital medical records. Associations between categorical variables were determined using Chi square test. Cox regression and Kaplan-Meier method estimated progression-free and overall survival.

RESULTS

Fifty-four IV and 17 IP treated patients after interval debulking were studied. The majority of patients had serous histology and grade 3 tumours. There was no significant difference between the two groups with respect to age and proportion of microscopic residual disease. Patients with macroscopic residual disease had a significantly worse prognosis (HR=2.17, 95% CI=1.23-3.85, p=0.008). Clinical complete response after primary treatment was 67% and 88% in the IV and IP group, respectively (p=0.36). Estimated mean progression-free survival was 18 months in the IV group and 14.1 months in the IP group (p=0.42). IP chemotherapy was not predictive of progression-free survival in the Cox model adjusted for age and residual disease status (HR=1.22, 95% CI=0.62-2.4, p=0.56). Estimated mean survival was 68.9 months in the IV group and 37.5 months in the IP group (p=0.85).

CONCLUSIONS

Survival benefit associated with IP chemotherapy after optimal upfront surgery may not translate to the neoadjuvant setting.