Intraperitoneal chemotherapy for the initial management of XXXX .

@entity43 @entity1 @entity137 @entity2167 @entity158
BACKGROUND: @entity43 tends to be chemosensitive and confine itself to the surface of the peritoneal cavity for much of its natural history. These features have made it an obvious target for intraperitoneal (IP) chemotherapy. Chemotherapy for @entity43 is usually given as an intravenous (IV) infusion repeatedly over five to eight cycles. Intraperitoneal chemotherapy is given by infusion of the chemotherapeutic agent directly into the peritoneal cavity. There are biological reasons why this might increase the anticancer effect and reduce some systemic adverse effects in comparison to IV therapy. OBJECTIVES: To determine if adding a component of the chemotherapy regime into the peritoneal cavity affects overall survival, progression-free survival, quality of life (QOL) and @entity137 in the primary treatment of @entity43 . SEARCH METHODS: We searched the Gynaecological Cancer Review Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2011, MEDLINE (1951 to May 2011) and EMBASE (1974 to May 2011). We updated these searches in February 2007, August 2010, May 2011 and September 2015. In addition, we handsearched and cascade searched the major gynaecological oncology journals up to May 2011. SELECTION CRITERIA: The analysis was restricted to randomised controlled trials (RCTs) assessing @entity1 with a new diagnosis of @entity43 , of any FIGO stage, following primary cytoreductive surgery. Standard IV chemotherapy was compared with chemotherapy that included a component of IP administration. DATA COLLECTION AND ANALYSIS: We extracted data on overall survival, disease-free survival, adverse events and QOL and performed meta-analyses of hazard ratios (HR) for time-to-event variables and relative risks (RR) for dichotomous outcomes using RevMan software. MAIN RESULTS: Nine randomised trials studied 2119 @entity1 receiving primary treatment for @entity43 . We considered six trials to be of high quality. @entity1 were less likely to die if they received an IP component to chemotherapy (eight studies, 2026 @entity1 ; HR = 0.81; 95% confidence interval (CI): 0.72 to 0.90). Intraperitoneal component chemotherapy prolonged the disease-free interval (five studies, 1311 @entity1 ; HR = 0.78; 95% CI: 0.70 to 0.86). There was greater serious @entity137 with regard to gastrointestinal effects, @entity158 but less @entity2167 with the IP than the IV route. AUTHORS' CONCLUSIONS: Intraperitoneal chemotherapy increases overall survival and progression-free survival from advanced @entity43 . The results of this meta-analysis provide the most reliable estimates of the relative survival benefits of IP over IV therapy and should be used as part of the decision making process. However, the potential for catheter related complications and @entity137 needs to be considered when deciding on the most appropriate treatment for each individual @entity1 . The optimal dose, timing and mechanism of administration cannot be addressed from this meta-analysis. This needs to be addressed in the next phase of clinical trials.
