Skip to main content
Log in

Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals

  • Special Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Peritoneal carcinomatosis, considered years ago as a final stage of unresectable cancer, can now be managed with curative intention by means of a radical cytoreductive surgical procedure with associated peritonectomy and intraperitoneal chemotherapy, as described by Sugarbaker. Malignant neoplasms such as mesothelioma and pseudomyxoma peritonei, ovarian and colon cancer nowadays are experiencing some new therapeutical approaches. Higher survival rates can be reached in ovarian cancer, which is commonly diagnosed in the presence of peritoneal carcinomatosis, using an optimal cytoreductive radical surgery with intraperitoneal chemotherapy. An actualised review of the treatment of advanced ovarian cancer and a proposal of a national multicentre protocol for the treatment of peritoneal carcinomatosis from ovarian cancer has been performed by a group of Spanish surgeons and oncologists dedicated to a therapeutical approach to this pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Jemal A, Siegel RT, Ward E et al (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66

    Article  PubMed  Google Scholar 

  2. Poveda A (2003) Ovarian cancer treatment: what is new. Int J Gynecol Cancer 13:241–250

    Article  PubMed  Google Scholar 

  3. Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14:254–261

    Article  PubMed  CAS  Google Scholar 

  4. Jahne J, Piso P (1998) Peritonectomy and intraperitoneal chemotherapy — new methods in multi-modality therapy of peritoneal carcinosis. Langenbecks Arch Chir Suppl Kongressbd 115:1435–1437

    PubMed  CAS  Google Scholar 

  5. Coakley FV (2002) Staging ovarian cancer: role of imaging. Radiol Clin North Am 40:609–636

    Article  PubMed  Google Scholar 

  6. Nelson RC, Chezmar JL, Hoel MJ et al (1992) Peritoneal carcinomatosis: preoperative CT with intraperitoneal contrast material. Radiology 182:133–138

    PubMed  CAS  Google Scholar 

  7. Coakley FV, Choi PH, Gougoutas CA et al (2002) Peritoneal metastases: detection with spiral CT in patients with ovarian cancer. Radiology 223:495–499

    Article  PubMed  Google Scholar 

  8. Tempany CM, Zou KH, Silverman SG et al (2000) Staging of advanced ovarian cancer: comparison of imaging modalities-report from the Radiological Diagnostic Oncology Group. Radiology 215:761–767

    PubMed  CAS  Google Scholar 

  9. Zimny M, Siggelkow W, Schroder W et al (2001) 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography in the diagnosis of recurrent ovarian cancer. Gynecol Oncol 83:310–315

    Article  PubMed  CAS  Google Scholar 

  10. Cho SM, Ha HK, Byun JY et al (2002) Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer. AJR Am J Roentgenol 179:391–395

    PubMed  Google Scholar 

  11. Pannu HK, Bristow RE, Cohade C et al (2004) PET-CT in recurrent ovarian cancer: initial observations. Radiographics 24:209–223

    Article  PubMed  Google Scholar 

  12. Childers JM, Lang J, Surwit EA, Hatch KD (1995) Laparoscopic surgical staging of ovarian cancer. Gynecol Oncol 59:25–35

    Article  PubMed  CAS  Google Scholar 

  13. Abu-Rustum NR, Chi DS, Curtin JP (1999) Epithelial ovarian cancer. Curr Probl Surg 36:1–56

    Article  PubMed  CAS  Google Scholar 

  14. Vergote I (2004) Role of surgery in ovarian cancer: an update. Acta Chir Belg 104:246–256

    PubMed  CAS  Google Scholar 

  15. Bristow RE, Tomacruz RS, Armstrong DK et al (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259

    Article  PubMed  Google Scholar 

  16. Hoskins WJ, McGuire WP, Brady MF et al (1994) The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 170:974–980

    PubMed  CAS  Google Scholar 

  17. Hoskins WJ, Bundy BN, Thigpen JT, Omura GA (1992) The influence of cytoreductive surgery on recurrence-free interval and survival in small-volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 47:159–166

    Article  PubMed  CAS  Google Scholar 

  18. Begossi G, Gonzalez-Moreno S, Ortega-Perez G et al (2002) Cytoreduction and intraperitoneal chemotherapy for the management of peritoneal carcinomatosis, sarcomatosis and mesothelioma. Eur J Surg Oncol 28:80–87

    Article  PubMed  CAS  Google Scholar 

  19. Sugarbaker PH (2000) It’s what the surgeon doesn’t see that kills the patient. J Nippon Med Sch 67:5–8

    Article  PubMed  CAS  Google Scholar 

  20. Elías D, Detroz B, Debaene B et al (1994) Treatment peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: reliable and unreliable concepts. Hepatogastroenterology 41:207–213

    PubMed  Google Scholar 

  21. Herrin VE, Thigpen JT (1999) Chemotherapy for ovarian cancer: current concepts. Semin Surg Oncol 17:181–188

    Article  PubMed  CAS  Google Scholar 

  22. Mekhail TM, Markman M (2002) Paclitaxel in cancer therapy. Expert Opin Pharmacother 3:755–766

    Article  PubMed  CAS  Google Scholar 

  23. Mohamed F, Sugarbaker PH (2003) Intraperitoneal taxanes. Surg Oncol Clin N Am 12:825–833

    Article  PubMed  Google Scholar 

  24. Francis P, Rowinsky E, Schneider J et al (1995) Phase I feasibility and pharmacologic study of weekly intrapertioneal paclitaxel: a Gynecologic Oncology Group pilot study. J Clin Oncol 13:2961–2967

    PubMed  CAS  Google Scholar 

  25. Mohamed F, Marchettini P, Stuart OA, Sugarbaker PH (2003) Thermal enhancement of new chemotherapeutic agents at moderate hyperthermia. Ann Surg Oncol 10:463–468

    Article  PubMed  Google Scholar 

  26. de Bree E, Rosing H, Michalakis J et al (2006) Intrapertioneal chemotherapy with taxanes for ovarian cancer with peritoneal dissemination. Eur J Surg Oncol 32:666–670

    Article  PubMed  Google Scholar 

  27. Steller MA, Egorin MJ, Trimble EL et al (1999) A pilot phase I trial of continuous hyperthermic peritoneal perfusion with high-dose carboplatin as primary treatment of patients with small-volume residual ovarian cancer. Cancer Chemother Pharmacol 43:106–114

    Article  PubMed  CAS  Google Scholar 

  28. van der Vange N, van Goethem AR, Zoetmulder FA et al (2000) Extensive cytoreductive surgery combined with intra-operative intraperitoneal perfusion with cisplatin under hyperthermic conditions (OVHIPEC) in patients with recurrent ovarian cancer: a feasibility pilot. Eur J Surg Oncol 26:663–668

    Article  PubMed  Google Scholar 

  29. Cavaliere F, Perri P, Di Filippo F et al (2000) Treatment of peritoneal carcinomatosis with intent to cure. J Surg Oncol 74:41–44

    Article  PubMed  CAS  Google Scholar 

  30. Deraco M, Rossi CR, Pennacchioli E et al (2001) Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion in the treatment of recurrent epithelial ovarian cancer: a phase II clinical study. Tumori 87:120–126

    PubMed  CAS  Google Scholar 

  31. Panteix G, Beaujard A, Garbit F et al (2002) Population pharmacokinetics of cisplatin in patients with advanced ovarian cancer during intraperitoneal hyperthermia chemotherapy. Anticancer Res 22(2B):1329–1336

    PubMed  CAS  Google Scholar 

  32. de Bree E, Romanos J, Michalakis J et al (2003) Intraoperative hyperthermic intrapertioneal chemotherapy with docetaxel as second-line treatment for peritoneal carcinomatosis of gynaecological origin. Anticancer Res 23(3C):3019–3027

    PubMed  Google Scholar 

  33. Zanon C, Clara R, Chiappino I et al (2004) Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer. World J Surg 28:1040–1045

    Article  PubMed  Google Scholar 

  34. Ryu KS, Kim JH, Ko HS et al (2004) Effects of intraperitoneal hyperthermic chemotherapy in ovarian cancer. Gynecol Oncol 94:325–332

    Article  PubMed  CAS  Google Scholar 

  35. Piso P, Dahlke MH, Loss M, Schlitt HJ (2004) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in peritoneal carcinomatosis from ovarian cancer. World J Surg Oncol 2:21

    Article  PubMed  Google Scholar 

  36. Reichman TW, Cracchiolo B, Sama J et al (2005) Cytoreductive surgery and intraoperative hyperthermic chemoperfusion for advanced ovarian carcinoma. J Surg Oncol 90:51–56

    Article  PubMed  Google Scholar 

  37. Rufián S, Muñoz-Casares FC, Briceño J et al (2006) Radical surgery-peritonectomy and intraoperative intraperitoneal chemotherapy for the treatment of peritoneal carcinomatosis in recurrent or primary ovarian cancer. J Surg Oncol 94:316–324

    Article  PubMed  Google Scholar 

  38. Raspagliesi F, Kusmaura S, Campos Torres JC et al (2006) Cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy in advanced/recurrent ovarian cancer patients: the experience of National Cancer Institute of Milan. Eur J Surg Oncol 32:671–675

    Article  PubMed  CAS  Google Scholar 

  39. Helm CW, Randall-Whitis L, Martin RS 3rd et al (2006) Hyperthermic intraperitoneal chemotherapy in conjunction with surgery for the treatment of recurrent ovarian carcinoma. Gynecol Oncol 105:90–96

    Article  PubMed  CAS  Google Scholar 

  40. McGuire V, Jesser CA, Witthemore AS (2002) Survival among US women with invasive epithelial ovarian cancer. Gynecol Oncol 84:399–403

    Article  PubMed  Google Scholar 

  41. Tentes AA, Tripsiannis G, Markakidis SK et al (2003) Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol 29:69–73

    Article  PubMed  Google Scholar 

  42. Sugarbaker PH (1995) Pertionectomy procedures. Ann Surg 221:29–42

    PubMed  CAS  Google Scholar 

  43. Sugarbaker PH (1996) Complete parietal and visceral peritonectomy of the pelvis for advanced primary and recurrent ovarian cancer. Cancer Treat Res 81:75–87

    PubMed  CAS  Google Scholar 

  44. Panici PB, Maggioni A, Hacker N et al (2005) Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst 97:560–566

    Article  PubMed  Google Scholar 

  45. Kyrgiou M, Salanti G, Pavlidis N et al (2006) Survival benefits with diverse chemotherapy regimens for ovarian cancer: meta-analysis of multiple treatments. J Natl Cancer Inst 98:1655–1663

    PubMed  CAS  Google Scholar 

  46. Elías D, Delperro JR, Sideris L et al (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: Impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol 11:518–521

    Article  PubMed  Google Scholar 

  47. Ozols RF, Bundy BN, Greer BE et al (2003) Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 21:3194–3200

    Article  PubMed  CAS  Google Scholar 

  48. du Bois A, Luck HJ, Meier W et al (2003) A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 95:1320–1329

    PubMed  Google Scholar 

  49. Armstrong DK (2002) Relapsed ovarian cancer: challenges and management strategies for a chronic disease. Oncologist 7:20–28

    Article  PubMed  CAS  Google Scholar 

  50. Arcuri C, Sorio R, Tognon G et al (2004) A phase II study of liposomal doxorubicin in recurrent epithelial ovarian carcinoma. Tumori 90:556–561

    PubMed  CAS  Google Scholar 

  51. du Bois A, Belau A, Wagner U et al for the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR) (2005) A phase II study of paclitaxel, carboplatin, and gemcitabine in previously untreated patients with epithelial ovarian cancer FIGO stage IC-IV (AGO-OVAR protocol OVAR-8). Gynecol Oncol 96:444–451

    Article  PubMed  CAS  Google Scholar 

  52. González-Martín A GEICO Group (2005) Treatment of recurrent disease: randomized trials of monotherapy versus combination chemotherapy. Int J Gynecol Cancer 15[Suppl 3]:241–246

    Article  Google Scholar 

  53. Alberts DS, Liu PY, Hannigan EV et al (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335:1950–1955

    Article  PubMed  CAS  Google Scholar 

  54. Markman M, Bundy BN, Alberts DS et al (2001) Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 19:1001–1007

    PubMed  CAS  Google Scholar 

  55. Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43

    Article  PubMed  CAS  Google Scholar 

  56. McGuire WP, Hoskins WJ, Brady MF et al (1995) Assessment of dose-intensive therapy in suboptimally debulked ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 13:1589–1599

    PubMed  CAS  Google Scholar 

  57. Conte PF, Bruzzone M, Carnino F et al (1996) High dose versus low dose cisplatin in combination with cyclophosphamide and epidoxorubicin in suboptimal ovarian cancer: a randomized study of the Gruppo Oncologico Nord-Ouest. J Clin Oncol 14:351–356

    PubMed  CAS  Google Scholar 

  58. Edmonson JH, Suman VJ, Dalton RJ et al (2001) Comparison of conventional dose and double dose carboplatin in patients receiving cyclophosphamide plus carboplatin for advanced ovarian carcinoma: a North Central Cancer Treatment Group Study. Cancer Invest 19:597–602

    Article  PubMed  CAS  Google Scholar 

  59. Lambrou N, Trimble EL (1999) Dose-intensive approaches to ovarian cancer. Curr Oncol Rep 1:54–58

    Article  PubMed  CAS  Google Scholar 

  60. Ansquer Y, Leblanc E, Clough K et al (2001) Neoadjuvant chemotherapy for unresectable ovarian carcinoma: a French multicenter study. Cancer 91:2329–2334

    Article  PubMed  CAS  Google Scholar 

  61. Jacob JH, Gershenson DM, Morris M et al (1991) Neoadjuvant chemotherapy and interval debulking for advanced epithelial ovarian cancer. Gynecol Oncol 42:146–150

    Article  PubMed  CAS  Google Scholar 

  62. Kayikcioglu F, Kose MF, Boran N et al (2001) Neoadjuvant chemotherapy or primary surgery in advanced epithelial ovarian carcinoma. Int J Gynecol Cancer 11:466–470

    Article  PubMed  CAS  Google Scholar 

  63. Vrscaj MU, Rakar S (2002) Neoadjuvant chemotherapy for advanced epithelial ovarian carcinoma: a retrospective case-control study. Eur J Gynaecol Oncol 23:405–410

    PubMed  Google Scholar 

  64. Shibata K, Kikkawa F, Mika M et al (2003) Neoadjuvant chemotherapy for FIGO stage III or IV ovarian cancer: Survival benefit and prognostic factors. Int J Gynecol Cancer 13:587–592

    Article  PubMed  CAS  Google Scholar 

  65. Markman M, Belinson J (2005) A rationale for neoadjuvant systemic treatment followed by surgical assessment and intraperitoneal chemotherapy in patients presenting with non-surgically resectable ovarian or primary peritoneal cancers. J Cancer Res Clin Oncol 131:26–30

    Article  PubMed  CAS  Google Scholar 

  66. Rose PG, Nerenstone S, Brady MF et al (2004) Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med 351:2489–2497

    Article  PubMed  CAS  Google Scholar 

  67. Ray-Coquard I, Saba C, Bachelot T et al (2006) Neoadjuvant chemotherapy and ovarian cancer. Bull Cancer 93:669–676

    PubMed  Google Scholar 

  68. Greer BE, Bundy BN, Ozols RF et al (2005) Implications of second-look laparotomy in the context of optimally resected stage III ovarian cancer: a non-randomized comparison using an explanatory analysis: a Gynecologic Oncology Group study. Gynecol Oncol 99:71–79

    Article  PubMed  Google Scholar 

  69. Linasmita V, Wilailak S, Thakkinstian A et al (2001) Advanced epithelial ovarian carcinoma in Thai women: should we continue to offer second-look laparotomy? J Med Assoc Thai 84:958–965

    PubMed  CAS  Google Scholar 

  70. Chu CS, Rubin SC (2001) Second-look laparotomy for epithelial ovarian cancer: a reappraisal. Curr Oncol Rep 3:11–18

    Article  PubMed  CAS  Google Scholar 

  71. Topuz E, Eralp Y, Saglam S et al (2004) Efficacy of intraperitoneal cisplatin as consolidation therapy in patients with pathologic complete remission following front-line therapy for epithlial ovarian cancer. Consolidative intraperitoneal cisplatin in ovarian cancer. Gynecol Oncol 92:147–151

    Article  PubMed  CAS  Google Scholar 

  72. Tournigand C, Louvet C, Molitor JL et al (2003) Long-term survival with consolidation intraperitoneal chemotherapy for patients with advanced ovarian cancer with pathological complete remission. Gynecol Oncol 91:341–345

    Article  PubMed  Google Scholar 

  73. Gori J, Castano R, Toziano M et al (2005) Intraperitoneal hyperthermic chemotherapy in ovarian cancer. Int J Gynecol Cancer 15:233–239

    Article  PubMed  CAS  Google Scholar 

  74. Bolis G, Danese S, Tateo S et al (2006) Epidoxorubicin versus no treatment as consolidation therapy in advanced ovarian cancer: results from a phase II study. Int J Gynecol Cancer 16[Suppl 1]:74–78

    Article  PubMed  Google Scholar 

  75. Verheijen RH, Massuger LF, Benigno BB et al (2006) Phase III trial of intraperitoneal therapy with yttrium-90-labeled HMFG1 murine monoclonal antibody in patients with epithelial ovarian cancer after a surgically defined complete remission. J Clin Oncol 24:571–578

    Article  PubMed  CAS  Google Scholar 

  76. Ozols RF (2006) Systemic therapy for ovarian cancer: current status and new treatments. Semin Oncol 33[2 Suppl 6]:3–11

    Article  CAS  Google Scholar 

  77. Verwaal VJ, van Ruth S, de Bree E et al (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21:3737–3743

    Article  PubMed  Google Scholar 

  78. Markman M (2001) Intraperitoneal chemotherapy in the management of malignant disease. Expert Rev Anticancer Ther 1:142–148

    Article  PubMed  CAS  Google Scholar 

  79. International Collaborative Ovarian Neoplasm Group (2002) Paclitaxel plus carboplatin versus standard chemotherapy with either singleagent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet 360:505–515

    Article  Google Scholar 

  80. Pecorelli S, Odicino F, Favalli G (2003) Consolidation therapies revisited: weekly paclitaxel. Int J Gynecol Cancer 13[Suppl 2]:208–211

    Article  PubMed  Google Scholar 

  81. Jacquet P, Sugarbaker PH (1996) Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res 15:49–58

    Google Scholar 

  82. Sugarbaker PH (1999) Tratamiento de las enfermedades malignas de la superficie peritoneal mediante quimioterapia intraperitoneal y cirugía citorreductora. Manual para médicos y enfermeras. Pamplona: Fundación Navarra de Investigaciones Quirúrgicas. González-Moreno S, Gómez-Portilla A (trans.)

  83. Esquivel J, Sugarbaker PH (1998) Elective surgery in recurrent colon cancer with peritoneal seeding: when to proceed and when not to. Cancer Therapeutics 1:321–325

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. C. Muñoz-Casares.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muñoz-Casares, F.C., Rufián, S., Rubio, M.J. et al. Treatment of peritoneal carcinomatosis from ovarian cancer. Present, future directions and proposals. Clin Transl Oncol 9, 652–662 (2007). https://doi.org/10.1007/s12094-007-0118-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-007-0118-0

Key words

Navigation