Ovarian cancer is the most deadly gynecologic malignancy. In the US alone, an estimated 21,500 new cases will be diagnosed in 2009, and an estimated 14,600 women will die from this disease.[1] Early-stage ovarian cancer is generally asymptomatic, so most patients with ovarian cancer present at an advanced stage of disease. The tumor stage is a significant prognostic variable, and patients with advanced disease have poorer outcomes.

Several large clinical trials were conducted to identify the best treatment options for women with advanced ovarian cancer. Data generated by these studies led to the 2006 National Cancer Institute (NCI) Clinical Announcement recommending that intraperitoneal (IP) chemotherapy become the standard of care for patients with newly diagnosed stage III optimally de-bulked epithelial ovarian cancer.[2] Table 1 summarizes the three main clinical trials that demonstrated a significant improvement in survival among ovarian cancer patients treated with chemotherapy via the IP route, as opposed to the intravenous (IV)-only route.[3–5] The NCI reported that clinical trials showed the IP method to be safe and effective, and this report sparked a renewed interest in IP chemotherapy.

In the past, healthcare providers were wary of IP chemotherapy for several reasons: IP chemotherapy required more resources and was more involved than IV chemotherapy. It required providers to master a new and complicated technique. Furthermore, there were concerns regarding IP chemotherapy study designs and outcomes. Healthcare providers needed to identify ideal candidates, that is, patients with limited, small-volume residual disease without adhesions. In addition, there were many reported toxicities with IP chemotherapy, including leukopenia and thrombocytopenia; gastrointestinal, renal, neurologic, and metabolic complications; fatigue; infection; and pain.[3–5] These toxicities may be expected with use of a higher IV cisplatin dose (100 mg/m2 vs 75 mg/m2) and addition of IP paclitaxel on day eight.[6] At Memorial Sloan-Kettering Cancer Center (MSKCC), we use a lower cisplatin dose (75 mg/m2) in an attempt to reduce these toxicities (see Table 2).