Response to neo-adjuvant intraperitoneal and intravenous immunochemotherapy followed by interval secondary cytoreduction in stage IIIc ovarian cancer

Design: The aim of this study was to determine the effect of intraperitonea l lip) neo-adjuvant immunochemotherapy, followed by secondary interval cyto reduction in bulky ovarian carcinoma, considered inoperable at first explor atory laparotomy. Patients and Methods: From 1980 to 1996. 13 naive patients with stage IIIc ovarian cancer underwent an initial laparotomy. Cytoreduction was judged to o dangerous in these patients due to the large bulk of the tumor and the ex tent of peritoneal carcinomatosis. Simple biopsies were performed. The pati ents received an intraperitoneal cisplatin-based protocol monthly plus immu notherapy (DGZ). The interval secondary cytoreduction was started either wh en the patients seemed to be in complete remission or after a minimum of 4 courses of chemotherapy if the patients' results were stagnant or deteriora ted. Immunochemotherapy was then resumed for a total of up to 10 courses. Results: At secondary cytoreduction. six patients were in complete remissio n as demonstrated histologically and cytologically. Seven patients were in incomplete remission. In six. debulking was completed without visceral rese ction. The seventh patient still had nodules more than 2 cm in diameter. Me dian overall survival was 57 months (range: 6-165). Conclusion: Intraperitoneal immunochemotherapy was effective in bulky tumor s, making optimal secondary cytoreduction possible in almost all cases.