Cytoreductive surgery and perioperative intraperitoneal chemotherapy for the treatment of advanced primary and recurrent ovarian cancer

Purpose of review With a steady incidence in the United States and worldwide, ovarian cancer remains the number one cause of death from gynecological malignancies. The conventional treatment approach for advanced ovarian malignancy is surgical debulking and systemic chemotherapy. More than 50% of these patients relapse within 5 years. Recent findings For advanced primary and recurrent disease, a comprehensive approach including cytoreductive surgery and perioperative intraperitoneal chemotherapy, based on the experience with other peritoneal surface malignancies is proposed. The goal of these treatments is to surgically eradicate all visible tumor and to chemically and physically eradicate microscopic residual disease. Cytoreductive surgery includes peritonectomy procedures and visceral resections. At the Washington Cancer Institute, cisplatin and doxorubicin are administered through the intraperitoneal route with heat during the surgical procedure. In the first 5 postoperative days, patients receive normothermic intraperitoneal paclitaxel. Summary Results of several phase II trials with this comprehensive approach suggested improved survival as compared with historical controls with reasonable morbidity and mortality.