Abdominal chemo boosts survival for ovarian cancer

Some women with one of the deadliest forms of ovarian cancer are likely to live longer if they receive chemotherapy in an unconventional way, investigators have found.

Fewer than half of the 2,400 women in Canada diagnosed with ovarian cancer each year survive five years. About 80 per cent are diagnosed after the cancer has spread because the early symptoms are mild.

One chemotherapy regimen boosted survival by an average16 months, Dr. Deborah Armstrong of the Johns Hopkins Kimmel Cancer Center in Baltimore and her colleagues found after studying 415 women.

Half of the women in the study got standard intravenous chemotherapy with Taxol and cisplatin. The other 205 women took IV Taxol as well as cisplatin administered by catheter straight into the abdomen, and more Taxol at high doses.

"It's probably the most significant discovery within the last 10 years," said Dr. Barry Rosen, a gynecologic cancer specialist at Princess Margaret Hospital in Toronto, who's among a small group of oncologists using the treatment in Canada.

Relapse-free survival for those receiving abdominal chemo was also better; 23.8 months compared with 18.3 months for those getting conventional chemo, the researchers report in Thursday's issue of The New England Journal of Medicine.

The abdominal treatment, called intraperitoneal or IP chemo, is not new, although the U.S. National Cancer Institute is now urging doctors to start using it in women whose advanced cancer has been surgically removed or minimized.

The approach may work better because it is difficult for IV chemo drugs to reach all cancer cells in the abdominal cavity. Women who received IP chemo were rolled back and forth to surround cancer cells in the medication.

Overcoming side effects

Participants in the study reported abdominal pain from bloating and catheter problems such as infection. Only 42 per cent of those receiving IP chemo could tolerate all six rounds, citing side-effects like fatigue, nausea and anemia. The study's authors hope the problems can be overcome by trying different amounts and combinations of drugs and catheter types.

Before the treatment is available to most Canadians, hospitals will need trained staff and specialized equipment, which could take two years, said Dr. Diane Provencher, president of the Society of Gynecologic Oncologists of Canada in Montreal. Even then, it will be limited to larger centres.

By the time Elana Waldman, 32, of Toronto was diagnosed, the cancer had spread to her ovaries, coating part of her liver, part of her diaphragm and was in her peritoneal cavity.

"I have a two-and-a-half-year-old, and should there be a recurrence, it makes a difference of my seeing her until she's 7 or until she's 9," said Waldman. "I don't think that you can really say that's not worth it."

Women with adhesions, surgical complications, poor kidney function, and those who have had the left side of their colon removed during surgery are not ideal candidates for IP therapy, the study's authors said.

Candidates are Stage 3 ovarian cancer patients who have had comprehensive surgery, Rosen said. It's not clear if the procedure helps recurrent disease or women with large amounts of disease after the surgery.