Cited rationale for variance in the use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian carcinoma at a high intraperitoneal chemotherapy utilization center
Brooke A Schlappe, Jennifer J Mueller, Oliver Zivanovic, Ginger J Gardner, Kara Long Roche, Yukio Sonoda, Dennis S Chi, Roisin E O'Cearbhaill, Brooke A Schlappe, Jennifer J Mueller, Oliver Zivanovic, Ginger J Gardner, Kara Long Roche, Yukio Sonoda, Dennis S Chi, Roisin E O'Cearbhaill
Abstract
Objective: Studies have demonstrated improved ovarian cancer survival with the administration of a combination of intravenous (IV) and intraperitoneal (IP) chemotherapy following optimal cytoreduction. Despite this, IV/IP chemotherapy is not uniformly used. In this retrospective cohort study, we assessed the documented reasons for giving IV-only chemotherapy.
Methods: All patients who had optimal primary cytoreductive surgery for stage III ovarian, fallopian tube, or primary peritoneal carcinoma, met eligibility criteria for GOG-172, and received primary chemotherapy at our institution between 2006 and 2013 were identified. Patients who received at least one cycle of adjuvant IV/IP therapy were included in the IP group. Patient characteristics, treatment information, and reason cited for not administering IP therapy were collected.
Results: Of the patients evaluated, 330 met inclusion criteria. The majority (n=261, 79%) received at least one IV/IP cycle (median, 6; range, 1-6), and 62% completed 6cycles. The most common reason for giving IV-only therapy was postoperative status (i.e., delayed wound healing, performance status), accounting for 18 (26%) of the 69 IV-only patients (5% of the entire cohort). Other cited reasons were baseline comorbidities (15%) and IP port complications (12%). Receipt of ≥1cycle of IP chemotherapy (HR 0.51; 95% CI, 0.32-0.80) and no gross residual disease (HR 0.47; 95% CI, 0.31-0.71) were associated with improved overall survival.
Conclusion: Potentially modifiable factors identified as leading to the use of IV-only chemotherapy were postoperative status and IP port complications, which if altered, could potentially lead to increased IP chemotherapy use.
Keywords: GOG-172; Intraperitoneal chemotherapy; National Cancer Institute guideline adherence; Optimal cytoreduction; Rationale; Serous ovarian cancer.
Conflict of interest statement
CONFLICT OF INTEREST STATEMENT
The authors have no conflicts to disclose.
Copyright © 2016 Elsevier Inc. All rights reserved.
Source: PubMed