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A REVIEW OF INTRAPERITONEAL THERAPY OF HUMAN OVARIAN CARCINOMA

Departments or Obstetrics & Gynecology and Medicine, Brigham and Women's Hospital, Sidney Farber Cancer Institute and the Haryard Medical School, Boston, Massachusetts 02115.

Ovarian carcinoma disseminates by direct seeding throughout the peritoneal cavity. It involves surfaces of the abdominal viscera, as well as the diaphragm. Epithelial ovarian carcinoma responds to multiple-agent chemotherapy, if tumor implants are reduced to 1.5 cm in any single location by cytoreductive surgery. Greater antitumor activity than that achieved by systemic administration may be obtained by increasing the dose and getting high concentrations of the chemotherapeutic agent directly to the site of the residual tumor. Oncologists have adminis tered adriamycin into the peritoneal space using a permanent peritoneal dialysis catheter. Adriamycin added into two liters of dialysis solution can reach concentrations up to 400 times greater than those in plasma. The factor which limits the dose of intraperitoneal adriamycin is chemical peritonitis. Recently investiga tors have infused cis-diamminedichloro-platinum (CDDP) via the dialysis catheter. With this agent, four patients of 18 who had failed previous chemotherapy, showed an objective response. Finally, Corynebacterium parvum has also been administered intraperitoneally via the dialysis catheter. The permanent peritoneal catheter has at least two advantages: First, it permits intraperitoneal administration of the various chemotherapeutic agents, and second it permits easy sampling of the dialysis fluid for cytological analysis and for measurement of the peritoneal inflammatory activity, using antibody-dependent cell-mediated cytotoxicity assay. A new study now in progress will test the effect of recombinant interferon administered intraperitoneally to patients with ovarian cancer.

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