Abdominal Chemo Bests Traditional IV Treatment for Ovarian Cancer
By Serena Gordon
HealthDay Reporter on 01/04/2006
WEDNESDAY, Jan. 4 (HealthDay News) -- For women with ovarian cancer, chemotherapy delivered through an abdominal catheter may offer them the chance at a longer life than standard treatment does.
In a study comparing the intraperitoneal (through the abdomen) method for delivering chemotherapy to the more commonly used intravenous chemotherapy, researchers found that average survival time for women with stage III ovarian cancer could be increased by nearly 16 months -- to an average of 65.6 months -- with intraperitoneal therapy.
"This is the longest survival reported to date for advanced ovarian cancer," said study author Dr. Deborah Armstrong, an associate professor of oncology and gynecology and obstetrics at Johns Hopkins Kimmel Cancer Center in Baltimore.
In fact, she said, the results were so encouraging that intraperitoneal chemotherapy is now the standard treatment for stage III ovarian cancer with surgically removed tumors at Johns Hopkins.
A report on the research appears in the Jan. 5 issue of the New England Journal of Medicine.
Ovarian cancer affects one in every 57 U.S. women over a lifetime, according to the National Cancer Institute. Most cases occur in women over 50, although younger women can also be affected. Because ovarian cancer rarely produces noticeable symptoms in its early stages, the disease often isn't found until it's advanced and harder to treat successfully.
Four hundred and fifteen women with "optimally debulked" stage III ovarian cancer tumors were recruited for the new study. That means that surgeons were able to remove all or most of the tumor -- only women with less than a 1-centimeter mass remaining were included in the study. Stage III cancer means the cancer is in one or both ovaries and has spread to the lining of the abdomen (peritoneum) and/or the lymph nodes, according to the American Cancer Society.
The study volunteers were randomly assigned to one of two groups: One received standard intravenous chemotherapy consisting of the drugs paclitaxel and cisplatin. The other group received a combination of intravenous and intraperitoneal medications that included intravenous and intraperitoneal paclitaxel and intraperitoneal cisplatin in higher doses than were given to the intravenous-only group. Also in the second group, paclitaxel was delivered through both methods because it doesn't spread to the rest of the body as well as abdominally delivered cisplatin does, Armstrong said.
Intraperitoneal chemotherapy is infused directly into the abdomen through a catheter surgically placed under the skin. Armstrong said the catheter is generally placed under the lower left rib cage. Because the medicine is going directly to the area affected by the cancer, rather than throughout the body, higher doses of chemotherapy can often be used. However, the medications, particularly cisplatin, do eventually enter the bloodstream and spread throughout the body, hopefully killing any cancer cells that may have spread beyond the abdominal region, she said.
Patients in both groups were scheduled for six cycles of treatments, to be given approximately every three weeks.
Women in the intraperitoneal group were more likely to suffer from side effects, such as gastrointestinal difficulties, hematological problems, infection, fatigue, pain and neurological problems. Less than half completed all six cycles of intraperitoneal therapy, though most completed the intravenous portion of the chemotherapy. The most common reason for discontinuation of the intraperitoneal therapy was catheter-related problems, the researchers said.
Study participants in the intraperitoneal group also reported a lower quality of life during and soon after chemotherapy. However, when quality of life was assessed a year after treatment, the results were similar for both groups.
But, average survival times were significantly increased for women who received intraperitoneal therapy. While women who received intravenous chemotherapy had a median survival time of 49.7 months, women in the combination group had a median survival of 65.6 months, a 25 percent increase in survival time, the researchers said.
The average time before the disease recurred was also longer for women who received the combination therapy -- 23.8 months compared to 18.3 months for women on intravenous therapy alone, the study found.
Dr. Stephen Cannistra, director of gynecologic medical oncology at Beth Israel Deaconess Medical Center in Boston, wrote an accompanying editorial in the journal. He said, "We are slowly but surely making progress against this terrible disease."
"The regimen used in the Armstrong study has produced the largest survival advantage to date for patients with newly diagnosed, optimally debulked, stage III epithelial ovarian cancer," he said.
Cannistra said he is now offering this option to his patients, but added that it might not be widely available yet because it requires additional training to administer.
Both Armstrong and Cannistra said this therapy probably wouldn't be used for more advanced ovarian cancers, because they have spread throughout the body.
Armstrong recommended that any woman with a suspicious mass that could be cancerous either have the initial surgery done by a gynecological oncologist, or make sure a gynecological oncologist is on-call during the surgery. That way the oncologist can take over if cancer is found because outcomes after surgical removal of ovarian tumors by these specialists are generally much better, she said.
If stage III cancer is found, both Armstrong and Cannistra recommended discussing intraperitoneal chemotherapy with your physician, and if intraperitoneal chemotherapy isn't available, ask for a referral to a center experienced in this treatment.
More information
The American Cancer Society has more information on the types of treatment available for ovarian cancer.
