3.Primary chemotherapy for ovarian tumors:
For epithelial tumours : platinum based chemotherapy (cisplatin/carboplatin and paclitaxel)to be given.
For sex cord stromal tumours : platinum based chemotherapy (BEP or paclitaxel/carboplatin)can be given.
For germ cell tumour : BEP is useful.
Intraperitoneal chemotherapy: In optimally cytoreduced advanced ovarian cancer, Paclitaxel and cisplatin are administered via an intraperitoneal catheter.
Median duration of survival was more with this therapy.
Disadvantages :
Toxicity :hematologic, gastrointestinal, neurologic and metabolic complications are more. Catheter related complications can occur.
Not useful in the presence of extensive adhesions or extraperitoneal disease.
Basis: Ovarian cancer remains confined to the peritoneal cavity for a long time during its natural history.
Higher concentrations in the peritoneal cavity than anywhere else.
Higher concentrations at the tumor site and less systemic toxicity.
Ideal drug:
Neither a too small molecule (it does not stay long in the peritoneal cavity).
Nor a too big molecule (it does not enter systemic circulation in adequate concentration).
Cisplatin & Carboplatin – Good intra peritoneal & systemic concentrations.
Paclitaxel – Very good intra peritoneal concentration but poor systemic concentration. (large molecule).
Most studies have used combination of cisplatin and paclitaxel.
Neoadjuvant chemotherapy:
Few cycles of chemotherapy before debulking surgery.
May dry up the effusions, improve patient's performance, decreases postoperative morbidity.
For epithelial tumours : platinum based chemotherapy (cisplatin/carboplatin and paclitaxel)to be given.
For sex cord stromal tumours : platinum based chemotherapy (BEP or paclitaxel/carboplatin)can be given.
For germ cell tumour : BEP is useful.
Intraperitoneal chemotherapy: In optimally cytoreduced advanced ovarian cancer, Paclitaxel and cisplatin are administered via an intraperitoneal catheter.
Median duration of survival was more with this therapy.
Disadvantages :
Toxicity :hematologic, gastrointestinal, neurologic and metabolic complications are more. Catheter related complications can occur.
Not useful in the presence of extensive adhesions or extraperitoneal disease.
Basis: Ovarian cancer remains confined to the peritoneal cavity for a long time during its natural history.
Higher concentrations in the peritoneal cavity than anywhere else.
Higher concentrations at the tumor site and less systemic toxicity.
Ideal drug:
Neither a too small molecule (it does not stay long in the peritoneal cavity).
Nor a too big molecule (it does not enter systemic circulation in adequate concentration).
Cisplatin & Carboplatin – Good intra peritoneal & systemic concentrations.
Paclitaxel – Very good intra peritoneal concentration but poor systemic concentration. (large molecule).
Most studies have used combination of cisplatin and paclitaxel.
Neoadjuvant chemotherapy:
Few cycles of chemotherapy before debulking surgery.
May dry up the effusions, improve patient's performance, decreases postoperative morbidity.
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