Clinical outcomes of post-operative intraperitoneal chemotherapy for patients with early stage high grade serous ovarian cancer treated at British Columbia Cancer Agency

IntroductionIntraperitoneal (IP) chemotherapy is recommended for optimally debulked stage III ovarian cancer, and its benefit for prolonging overall and progression-free survival for advanced ovarian cancer was previously shown in randomized trials. In British Columbia, we extrapolated from this and have been using IP chemotherapy for stage I/II HGSC patients for the last 10 years. We conducted a retrospective study to review the clinical outcomes of using IP/IV chemotherapy compared to IV chemotherapy for optimally debulked stage 1 HGSC cases. MethodologyA retrospective chart review was performed on women with early-stage HGSC, who were optimally debulked at their primary surgery between 2007-2015 and received either IV or IP/IV chemotherapy postoperatively. We analyzed and compared the survival outcomes for women with stage 1A-1C HGSC. Kaplan-Meier method was used to correlate the chemotherapy delivery method with progression-free survival (PFS) and overall survival (OS), using the statistical program R. ResultsWe identified 99 patients; 80 (81%) received IV chemotherapy and 19 (19%) received IP/IV chemotherapy. All patients had high-grade serous tumors. Among IP/IV cohort, 2/19 (11%) dropped the IP therapy in the middle of their treatment due to abdominal pain at an IP port site or hypersensitivity reaction to IV paclitaxel. 5-year PFS was 88.4% (74.5-100%) and 69.7% (58.7-82.7%) among the IP/IV and IV cohorts, respectively (p=0.549). There was a trend for higher 5-year OS for the IP/IV group; however, this did not reach statistical significance (100% vs. 71.4%; p=0.182). ConclusionIn our study, IP/IV chemotherapy for optimally debulked stage 1 HGSC patients was associated with a trend for higher 5-year PFS and OS compared to IV chemotherapy, however, this was not statistically significant. Larger prospective study is warranted.