A systematic review and meta-analysis of randomized trials

Intraperitoneal (IP) chemotherapy for advanced ovarian cancer improves both overall and disease-free survival. In this chapter, we compare the effectiveness of intravenous (IV) to IP chemotherapy. The evidence suggests an improvement in survival if some of the chemotherapy is administered via the IP route. The adverse events principally relate to the presence of a peritoneal catheter, including pain, catheter blockage, gastrointestinal effects, and infection. A systematic search identified eight relevant randomized trials studying 1,819 women receiving primary treatment for ovarian cancer. Women were less likely to die if they received an IP component to the chemotherapy (hazard ratio = 0.80; 95% confidence interval [CI] = 0.71-0.90). Administering a component of chemotherapy by the IP route also prolongs the disease-free interval (0.79; 0.69-0.90) by almost 9mo and increases complete response rates. There may, however, be greater pain, fever, and gastrointestinal toxicity, but less ototoxicity, using the IP route.