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

Design: The aim of this study was to determine the effect of intraperitoneal (i.p.) neo-adjuvant immunochemotherapy, followed by secondary interval cytoreduction in bulky ovarian carcinoma, considered inoperable at first exploratory laparotomy.

Patients and methods: From 1980 to 1996, 13 naive patients with stage IIIc ovarian cancer underwent an initial laparotomy. Cytoreduction was judged too dangerous in these patients due to the large bulk of the tumor and the extent of peritoneal carcinomatosis. Simple biopsies were performed. The patients received an intraperitoneal cisplatin-based protocol monthly plus immunotherapy (DGZ). The interval secondary cytoreduction was started either when the patients seemed to be in complete remission or after a minimum of 4 courses of chemotherapy if the patients' results were stagnant or deteriorated. Immunochemotherapy was then resumed for a total of up to 10 courses.

Results: At secondary cytoreduction, six patients were in complete remission as demonstrated histologically and cytologically. Seven patients were in incomplete remission. In six, debulking was completed without visceral resection. The seventh patient still had nodules more than 2 cm in diameter. Median overall survival was 57 months (range: 6-165).

Conclusion: Intraperitoneal immunochemotherapy was effective in bulky tumors, making optimal secondary cytoreduction possible in almost all cases.

Ovarian cancer; Stage Ille; Intraperitoneal neoadjuvant chemotherapy; Immunotherapy

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