Intraperitoneal chemotherapy as primary treatment of advanced ovarian cancer: efficacy, toxicity, and future directions.

Three U.S. National Cancer Institute cooperative group randomized phase 3 trials have demonstrated that the intraperitoneal delivery of cisplatin-based chemotherapy as primary treatment of small-volume residual advanced ovarian cancer improves survival compared to the administration of all agents by the intravenous route. As use of intraperitoneal chemotherapy requires additional resources and expertise beyond that associated with routine intravenous treatment, and unique side effects may be observed (e.g., catheter malfunction, intra-abdominal infection), some have questioned the utility of this approach, despite the documented survival advantage. This review outlines the data supporting intraperitoneal delivery in ovarian cancer, discusses strategies to safely and effectively employ regional therapy, and highlights areas where future trials are required to optimize this novel method for treatment of this malignancy.