FIRST LINE IMMUNOCHEMOTHERAPY WITH CISPLATIN-BASED PROTOCOL BY INTRAPERITONEAL AND INTRAVENOUS ROUTES IN OVARIAN-CANCER - TECHNIQUE AND RESULTS OF 82 CASES

Objectives: The aim of this study, initiated in 1982, was to determine the feasibility and the interest of a first-line immunochemotherapy d elivered by intraperitoneal (i.p.) and intravenous (i.v.) routes combi ned in ovarian cancer. Study design: Eighty-two naive patients with a common epithelial cancer entered the study from January 1982 to Decemb er 1990 (median follow up > 70 months). For i.p. infusion, we used a s imple lumbar puncture needle left in situ for < 2 h. The first 18 pati ents received monthly by i.p. route: Adriamycin (DXR) 40 mg/m(2), Fluo rouracil 1000 mg/m(2), Cisplatin (CDDP) 90 mg/m(2), Bleomycin 30 mg - DGZ (extract of vibrio cholerae) 60 mg/m(2). For the remaining 64 pati ents Aracytin 500 mg/m(2) replaced DXR and the dose of CDDP was more t han doubled (200 mg/m(2)) thanks to the use of sodium thiosulfate. All 82 patients received Ifosfamid 1300 mg/m(2) intravenously. Results: L ocal toxicity consisted in one subcutaneous abscess and one bacterial peritonitis out of 1508 abdominal punctures. Stage III turned out to b e the most interesting group to evaluate the efficacy of a first-line protocol. In this group 34 out of 47 patients (72.3%) who underwent an initial incomplete surgery were in complete remission (CR) at second- look. Nevertheless, 21 out of the 34 patients in CR relapsed (61.7%) a nd 14 died (43.2%). Conclusion: These results show the efficacy of our regimen administered i.p., and the safety of the delivery by a simple needle which avoids the complications of the implantable systems. Nev ertheless, the usefulness of a systematic second-line chemotherapy (Pa clitaxel?), despite a prognosis situation as favorable as a CR at seco nd-look, must be taken into consideration.