Delivering chemotherapy directly to the abdomen can significantly improve survival among women with ovarian cancer—so significantly that nearly ten years ago, the National Cancer Institute issued a special clinical announcement urging oncologists to use the approach, called intraperitoneal chemotherapy. Unfortunately, many smaller hospitals and oncology practices still don’t offer it. Even at larger centers, fewer than half of eligible women receive the treatment, according to a recent study in the Journal of Clinical Oncology.
Roswell Park’s Shashikant Lele, MD, FACOG, uses intraperitoneal chemotherapy (IP therapy) to treat patients with ovarian, fallopian tube, and primary peritoneal cancers. “It’s the most effective way we have of delivering the chemotherapy to where the cancer is,” he says. “All patients with these cancers at Roswell Park are considered for this therapy.” Here, Dr. Lele answers some common questions about the treatment.
What is Intraperitoneal Chemotherapy?
Intraperitoneal chemotherapy delivers chemotherapy through a port in the abdomen, bathing the region in anticancer drugs to wipe out residual cancer cells that remain after surgery. Patients who have IP therapy typically receive it in addition to the usual intravenous chemotherapy. We use the same drugs for IP therapy as we do for IV chemotherapy.
When is it used?
IP therapy may benefit patients with ovarian or fallopian tube cancers that have spread, or patients with primary peritoneal cancer. These patients generally have advanced disease that has spread to the abdomen. First, the patient undergoes “debulking” surgery to remove all visible tumor. Typically there is a large tumor and as many as hundreds of tiny tumors measuring from 1 millimeter (mm) to 2-3 centimeters (cm) in diameter throughout the abdomen. The surgeon painstakingly removes all visible cancer, leaving no residual tumor behind, and no cancer nodules larger than 5mm. Debulking surgery may involve removing parts of the spleen, bowel and stomach, too.
How well does it work?
Research shows that the therapy improves overall survival significantly, by a median of 16 months, compared to IV chemotherapy alone. The key factor is whether the patient’s surgery is adequate. In the hands of gynecologic oncologists at Roswell Park, effective debulking is achieved in 80 percent of patients. In other facilities, where these surgeries are performed by general surgeons or gynecologists, only 40 percent are adequately debulked.
Which patients are eligible for IP therapy?
If a patient can undergo optimal tumor removal surgery, then the patient is eligible for IP therapy. Some patients may have factors such as extensive adhesions in the abdomen or other complications, which could exclude them from this therapy.
How is IP therapy conducted?
Treatment involves six sessions where the IP therapy is given simultaneously with IV therapy. Patients are gently rolled back and forth to ensure the drugs reach throughout the abdomen. Each session takes about 3 to 4 hours.
What should patients know?
If ovarian cancer is suspected, patients should seek treatment from a cancer center where the gynecologic oncologists have experience with debulking surgery and intraperitonal chemotherapy.