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Intra-operative intra-peritoneal chemotherapy with cisplatin in patients with peritoneal carcinomatosis of ovarian cancer

Emmanuel Guardiola1, Delphine Delroeux2, Bruno Heyd2, Marielle Combe3, Veronique Lorgis1, Martin Demarchi1, Ulrich Stein1, Bernard Royer4*, Bruno Chauffert5 and Xavier Pivot1

Author Affiliations

1 University Hospital Jean Minjoz, Department of Medical Oncology, 25030 Besançon Cedex, France

2 CHU Jean Minjoz, Department of surgery, University Hospital Jean Minjoz 25030 Besançon Cedex, France

3 Department of Anaesthesia-Intensive Care, 25030 Besançon Cedex, France

4 Department of Pharmacology, 25030 Besançon Cedex, France

5 Anti cancer center Georges-François Leclerc, 21000 Dijon, France

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World Journal of Surgical Oncology 2009, 7:14  doi:10.1186/1477-7819-7-14

Published: 9 February 2009

Abstract

Background

Intra-peritoneal (i.p.) chemotherapy is an encouraging treatment option for ovarian cancer with peritoneum involvement in addition with intravenous (i.v.) chemotherapy. Intra-operative i.p. chemotherapy is an interesting method of administration by enhancing the diffusion of chemotherapy. This study had assessed the feasibility of intra-operative i.p. chemotherapy in patients with peritoneal carcinoma of ovarian cancer.

Methods

From January 2003 to February 2006, 47 patients with stage III ovarian cancer were treated with standard paclitaxel carboplatin intravenous chemotherapy and debulking surgery with intra-operative i.p. chemotherapy. After optimal cytoreductive surgery, defined by no unresectable residual disease > 1 cm, i.p. chemotherapy was performed during surgery. The peritoneal cavity was filled by 3 litres of isotonic saline pre-heated at 37 degrees and 90 mg of cisplatin. The sequence was repeated twice during 2 hours based on previous published studies which optimized the cisplatin dosage and exposure duration. Optimal diffusion was obtained by stirring by hands during the 2 hours.

Results

Median age was 59.6 years. No severe haematological or non-haematological toxicity induced by intra operative i.p. chemotherapy was reported. No patient died due to the complications of surgery or the i.p. chemotherapy. No neurotoxicity occurred, and one patients had renal impairment.

Conclusion

This study demonstrates the feasibility of intra-operative i.p. chemotherapy with cisplatin after optimal resection of peritoneal tumor nodules. Further randomized trials are planned to investigate the clinical benefit of this therapeutic modality.