The concept of treating optimally debulked patients with intraperitoneal chemotherapy has appealed to clinicians for over two decades. In early 2006, a GOG study concluded that intraperitoneal treatment appeared superior in this subset of patients.66 This trial randomized 429 patients to either standard intravenous cisplatin plus paclitaxel or intraperitoneal/intravenous cisplatin plus paclitaxel (Fig. 8-11). The patients receiving intraperitoneal chemotherapy had a significant improvement in overall survival (median survival 65.6 versus 49.7 months). Toxicity, particularly neurotoxicity, was greater and quality-of-life scores were initially lower in patients treated with intraperitoneal chemotherapy. An earlier GOG randomized trial also provided strong evidence for the utility of intraperitoneal chemotherapy in optimally debulked patients.67 The NCCN has listed intraperitoneal therapy as an alternative manage ment for patients with optimal residual disease after primary cytoreduction, using the GOG regimen (see Fig. 8-8). Physicians may choose to prescribe this regimen or a modification of it to reduce the associated toxicity. The GOG is currently conducting phase I studies of intraperitoneal paclitaxel and intraperitoneal carboplatin to derive regimens with reduced toxicity.
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