Comprehensive management of epithelial ovarian cancer with peritoneal metastases

Table 1 Intraoperative bidirectional chemotherapy orders

Add cisplatin (50 mg/m2) ________ mg to 2 L of 1.5% dextrose peritoneal dialysis solution

Add doxorubicin (15 mg/m2) ________ mg to same 2 L of 1.5% dextrose peritoneal dialysis solution

Add ifosfamide (1300 mg/m2) ________ mg to 1 L normal saline

Begin continuous iv infusion over 90 min simultaneous with ip chemotherapy

Add mesna disulfide (260 mg/m2) ________ mg in 100 mL 0.9% sodium chloride to be given iv as a bolus 15 min prior to ifosfamide infusion

Add mesna disulfide (260 mg/m2) ________ mg in 100 mL 0.9% sodium chloride to be given iv as a bolus 4 h after ifosfamide infusion

Add mesna disulfide (260 mg/m2) ________ mg in 100 mL 0.9% sodium chloride to be given iv as a bolus 8 h after ifosfamide infusion

Send all the above to operating room No. _______ at _______ o’clock on ___________ (date) for a 90-min treatment

Table 2 Early postoperative intraperitoneal chemotherapy orders

Paclitaxel ________ mg (20-40 mg/m2× _______ m2) (maximum dose: 80 mg) in_______mL 6% Hespan® (Braun B, Irvine, CA) via the Tenckhoff catheter or IP port daily

Start date: ________________ Stop date: __________________ (For daily doses > 500 mL total volume, pharmacy will split dose equally into two bags)

Instill as rapidly as possible via the Tenckhoff catheter or ip port

Dwell for 23 h

Drain from Jackson-Pratt drains for one hour prior to the next instillation

Continue to drain the abdominal cavity by Jackson-Pratt drains after the last dose of ip chemotherapy

During the initial 6 h after chemotherapy instillation, patient’s bed should be kept flat

The patient should be on the right side during instillation

Turn ½ hour post instillation onto the left side and continue to change sides at ½ hour intervals for 6 h

Monitor with a pulse oximeter during the first 6 h of each intraperitoneal chemotherapy

Table 3 Clinical information from recent reports on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with peritoneal metastases from ovarian cancer

Ref.	n	Median follow-up (mo)	Median disease-free survival (mo)	Median overall survival (mo)	Overall 5-year survival (mo)	Median length of hospital stay (d)	Mortality (%)	Morbidity Grade 3 (%)	Morbidity Grade 4 (%)
Bereder et al[20]	246	NR	13	49	35	17	0.4	12
Pavlov et al[21]	56	60	26	38	NR	14	2	0	2
Fagotti et al[22]	25	18	10	NR	NR	13	0	8	8
Guardiola et al[23]	47	23	14	NR	NR	18	0	NR	13
Di Giorgio et al[24]	47	NR	20	24	17	221	4	9	13
Bae et al[25]	67	NR	NR	NR	66	NR	0	0	0
Cotte et al[26]	81	47	19	28	NR	172	3	5	2

¹Two-year survival results;

²Refers to results expressed as mean. NR: Not reported.