Intravenous chemotherapy, early debulking surgery, and consolidation intraperitoneal chemotherapy in advanced ovarian carcinoma

Objective. The efficacy of a cisplatin-anthracycline combination, early deb ulking surgery, and intraperitoneal chemotherapy has been demonstrated thro ugh separate studies. We evaluated a multimodal treatment strategy integrat ing these therapeutic options. Methods. Women with stage III or IV ovarian carcinoma received six cycles o f cisplatin/epirubicin alternating with leucovorin and 5-fluorouracil. Pati ents with a residual disease (RD) measuring more than 2 cm after the initia l laparotomy underwent an early debulking surgery after the first three cyc les of chemotherapy. A second-look laparotomy (SLL) was performed after six cycles of intravenous chemotherapy. Intraperitoneal chemotherapy with cisp latin, VP16, and mitoxantrone was then administered in patients with no or RD <2 cm after SLL. Results. A total of 87 patients were included. After initial laparotomy, 11 patients (12%) had no macroscopic residual disease, 38 (44%) had a RD less than or equal to2 cm, and 38 (44%) had a RD >2 cm. After early debulking s urgery, an additional 18 patients (21%) had a RD <2 cm. Seventy-five patien ts were evaluable for response to intravenous chemotherapy: the overall res ponse rate was 80%, and 30 patients achieved a pathological complete respon se (40%). Eight percent of the patients had stable disease and 12% had a pr ogression. Sixty-eight patients received intraperitoneal chemotherapy after second-look laparotomy. With a 72-month median follow-up, median overall s urvival and progression-free survival were, respectively, 37 and 19 months. Five-year survival was 41%. Conclusion. The prognosis of patients with advanced ovarian carcinoma may b e improved by a sequential treatment strategy including intravenous chemoth erapy, early debulking surgery, and intraperitoneal chemotherapy. (C) 2001 Academic Press.