Intraperitoneal Chemotherapy of Ovarian Cancer
Sammanfattning: Ovarian cancer is still the most common cause of death among gynecologic malignancies in spite of the fact that newer and more effective drugs and/or administration techniques have been developed in the last decade. However, substantial improvements in response rate andprogression-free survival have been reported in many studies.In this study the efficacy, toxicity and feasibility of different drugs administered IP were evaluated in patients with ovarian cancer. The maximum tolerated dose of carboplatin administered IP was determined to be 500 mg!m2 This dose was given adjuvantly in a phase IT study to 47 women with early-stage disease. There were 10 patients in this study who developed recurrent disease. The toxicity was acceptable, the major dose-limiting toxic effect being hematologic, especially thrombocytopenia. One patient developed grade 3 nephrotoxicity after the second course. There was no incidence of treatment-related death.Thirty-five patients with advanced ovarian cancer were treated with an aggressive combination regimen (cisplatin/etoposide) intraperitoneally with IV sodium thiosulphate as antidote. The dose-limiting toxic effect was hematologic. Two patients developed severe nephrotoxicity. The median progression-free interval was 13 months and the survival at closing point 31% with a median follow-up of 16 months.The patient acceptance and feasibility of using subcutaneously implantable peritoneal access devices were analyzed in 125 patients. Port-A-Cath was used in 98% of the patients, 465 IP courses were administered and 27 (21.6%) severe or moderate complications related to Port-A-Cath were registered.The incidence of nephrotoxicity in patients treated IP with platinum-containing regimens was analysed. Six of 135 patients (4%) developed severe nephrotoxicity; impairment of renal function, as judged by serum creatinine, was seen in most patients. This was cumulative during treatment and not completely reversible. Young age was a predictive factor for severe nephrotoxicity.
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