A recent clinical trial has shown promising results from giving chemotherapy directly into the tummy (abdomen) of women with advanced ovarian cancer. This type of treatment is called intraperitoneal chemotherapy.

The study looked at women with cancer of the ovary that had spread beyond the pelvis to nearby lymph nodes or to the lining of the abdomen (omentum) or the upper part of the bowel. This is called stage 3 ovarian cancer.

The usual treatment for stage 3 ovarian cancer is an operation to remove as much of the tumour as possible, followed by 4–6 months of chemotherapy given into a vein (intravenously) once every 3–4 weeks.

Chemotherapy can often make any remaining cancer shrink or even disappear. However it's not a cure and eventually, the cancer comes back. So research is going on all the time to find ways of improving the results of treatment

In the recent clinical trial women, with stage 3 ovarian cancer, had surgery. They then had either intravenous chemotherapy alone or intravenous chemotherapy plus intraperitoneal chemotherapy.

All of the women were given paclitaxel chemotherapy intravenously once every three weeks, on six occasions. On the day after the paclitaxel half the women had intravenous cisplatin chemotherapy. The other half were given cisplatin through a tube (a catheter) placed directly into their abdomen, then one week later paclitaxel, also through the catheter.

The results of the study showed that women who had the intraperitoneal chemotherapy lived on average about a year longer than the women who had intravenous therapy alone.

This is good news. However there are some drawbacks to having chemotherapy in this way.

In the study, intraperitoneal therapy caused more problems with side-effects, such as tiredness, abdominal pain and infections. This meant that women having it had a poorer quality of life during, and for some weeks after treatment, than women who only had the intravenous drugs. In fact less than half the women who were planned to have the intraperitoneal therapy were able to complete it.

The intraperitoneal therapy is much more time consuming, with many more hospital visits for treatment and for care of the catheter, which stays in place throughout the months of chemotherapy. It also needs specially trained staff to give it.

For these reasons, intraperitoneal chemotherapy is still an experimental treatment for advanced ovarian cancer, and is not widely available in the UK. However, encouraged by these recent results many specialists in ovarian cancer are looking closely at this way of giving treatment and trying to find ways of reducing the side-effects and making it easier to cope with.

References

• Armstrong DR et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. New England Journal of Medicine, 2006; 354: 34-43
• Cannistra SA. Intraperitoneal chemotherapy comes of age. New England Journal of Medicine, 2006; 354: 77-79