Intraperitoneal Adriamycin in Ovarian Cancer

Abstract

Ovarian cancer is the leading cause of death from a gynecologic malignancy in the United States, accounting for an estimated 11,000 deaths in 1980. Its natural history is characterized by a propensity to remain confined to the abdomen virtually throughout its entire clinical course. Malignant cells spread from their origin in an involved ovary via lymphatic drainage, contiguous spread, and by peritoneal seeding to serosal surfaces throughout the peritoneum. As a consequence of this pattern of metastases, therapeutic approaches have focused on the eradication of intraabdominal disease. Patients with advanced stage ovarian cancer (FIGO stage III–IV with disease outside the pelvis) have been treated with surgery to remove as much of the disease as technically feasible followed by postoperative chemotherapy or radiotherapy. Both of these modalities of treatment have been effective in controlling intraabdominal disease in patients with minimal residual disease (tumor masses less than 2.0 cm in diameter), i.e., a 100% complete response rate to HexaCAF combination chemotherapy (1) and a 65% 5-year survival with whole abdominal radiotherapy (2). However, patients with bulky residual disease have a markedly worse prognosis. Although the overall response rate to a variety of combination chemotherapy regimens is 60%–80% (3), the majority of these patients will not achieve a pathologically determined complete response to therapy and will eventually succumb to the regrowth of their intraabdominal disease.