4. Surgical and chemotherapeutic cytoreduction for advanced primary and recurrent ovarian cancer, the Washington Cancer Institute approach

Ovarian cancer remains the number one cause of death from gynecological malignancies. Currently, the conventional treatment approach for advanced (stage III and IV) ovarian malignancy is surgical debulking and systemic chemotherapy. Negative second-look laparotomy is attainable in only 20 to 40% of the cases. Up to 47% of these patients relapse within 5 years. In an effort to improve the results of treatment a Comprehensive Approach including cytoreductive surgery and perioperative intraperitoneal chemotherapy has been utilized. This approach is based on the success achieved with other peritoneal surface malignancies. The goal of these treatments is to surgically eradicate all visible tumor and then to chemically eradicate microscopic residual disease. Cytoreductive surgery includes peritonectomy procedures and visceral resections. Cisplatin and doxorubicin are administered through the intraperitoneal route with heat during the surgical procedure. In the first five postoperative days patients receive normothermic intraperitoneal paclitaxel. Results of a phase II trial with this Comprehensive Approach suggests improved survival as compared to historical controls with reasonable morbidity and mortality. Correspondence/Reprint request: Dr. Paul H. Sugarbaker, Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington, DC, USA. E-mail: [email protected] Paul H. Sugarbaker 52