Evaluation of survival after second‐line intraperitoneal cisplatin‐based chemotherapy for advanced ovarian cancer

Abstract

Background. The authors sought to evaluate survival of patients with ovarian cancer treated with second‐line intraperitoneal cisplatin‐based chemotherapy. Methods. From August 1985 to September 1991, 63 patients with recurrent or persistent ovarian cancer after first‐line cisplatin‐based chemotherapy were on a protocol and treated with cisplatin, cytarabine, with or without bleomycin. Eligibility included Stage III/IV invasive adenocarcinoma of the ovary, documentation of the size of residual disease at reoperation, and prior treatment with first‐line intravenous cisplatin‐based chemotherapy. Results. The median survival from intraperitoneal chemotherapy was 29 months. For patients who responded to first‐line chemotherapy and second‐line intraperitoneal chemotherapy, the 5‐year survival was 60%, but for patients with response to first‐line chemotherapy but no response to intraperitoneal chemotherapy the 5‐year survival was only 17%, and no patient survived 5 years who did not have a response to first‐ or second‐line therapy (P < 0.0001). There was significant improvement in the 2‐year survival from initiation of intraperitoneal chemotherapy for patients with ≤ 5 mm residual tumor in greatest dimension (74%), compared with patients with residual tumor larger than 5 mm and smaller than or equal to 2 cm (38%), and patients with residual tumor larger than 2 cm (0%) (P < 0.0001). Conclusion. Survival was increased for patients who (1) had a response to first‐line intravenous chemotherapy and second‐line intraperitoneal chemotherapy and (2) who had residual tumor 5 mm or smaller at the initiation of intraperitoneal therapy. The conclusion that the prolonged survival is secondary to cisplatin‐based chemotherapy administered intraperitoneally must be made with caution because survival may have been secondary to the small residual disease at initiation of second‐line chemotherapy or the systemic effect of cisplatin. Copyright © 1994 American Cancer Society