CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(01): 074-080
DOI: 10.1055/s-0042-1751098
Original Article
Ovarian Cancer

NIPEC with Single-Dose Intraperitoneal Cisplatin and Paclitaxel in Stage III Epithelial Ovarian Cancer

Elroy Saldanha
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Sanjay M. Desai
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Vinod Dhakad
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Sandeep Ghosh
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Varun Prakash
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Harsha Deepti
1   Department of Surgical Oncology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
Ashma Monteiro
2   Department of Statistics, Kasturba Medical College, Manipal, Karnataka, India
› Author Affiliations


Zoom Image
Sanjay M. Desai

Objectives Epithelial ovarian cancer (EOC) is a heterogeneous, essentially peritoneal disease. Standard treatment consists of staging, cytoreductive surgery (CRS), and adjuvant chemotherapy. In this study, we intended to assess the effectiveness of single-dose intraperitoneal (IP) chemotherapy in optimally debulked advanced EOC patients.

Materials and Methods A prospective randomized study of 87 patients with advanced EOC was done from January 2017 to May 2021 in a tertiary care center. Patients who underwent primary and interval cytoreduction received a single dose of IP chemotherapy for 24 hours after being divided into four groups: group A, IP cisplatin; group B, IP paclitaxel; group C, IP paclitaxel and cisplatin; and group D, saline. Pre- and postperitoneal IP cytology was assessed along with possible complications.

Statistical Analysis Logistic regression analysis was used to assess for intergroup significance in cytology and complications. Kaplan–Meir analysis was done to assess disease-free survival (DFS).

Results Of 87 patients, 17.2% of patients had FIGO stage IIIA, 47.2% had IIIB, and 35.6% had IIIC. Also, 22 (25.3%) patients were in group A (cisplatin), 22 (25.3%) patients in group B (paclitaxel), 23 (26.4%) in group C (cisplatin and paclitaxel), and 20 (23%) in group D (saline). Cytology samples taken during staging laparotomy were positive, and 48 hours post-IP chemotherapy, 2 (9%) of 22 samples in cisplatin group and 14 (70%) of 20 samples in saline group were positive; all of the post-IP samples in groups B and C were negative. No major morbidity was noted. In our study, DFS in saline group was 15 months, while in IP chemotherapy group it was 28 months and was statistically significant based log-rank test. However, there was no significant difference in DFS between different IP chemotherapy groups.

Conclusion Complete or optimal CRS in advanced EOC does have a possibility of microscopic peritoneal residue. Adjuvant locoregional strategies should be considered to prolong DFS. Single-dose normothermic IP chemotherapy can be offered to the patients with minimal morbidity, and its prognostic benefits are comparable to hyperthermic IP chemotherapy. Future clinical trials are required to validate these protocols.

Publication History

Article published online:
15 August 2022

© 2022. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 IARC. GLOBOCAN: Cancer incidence, mortality and prevalence worldwide. Available at:
  • 2 Suidan RS, Zhou Q, Iasonos A. et al. Prognostic significance of the number of postoperative intraperitoneal chemotherapy cycles for patients with advanced epithelial ovarian cancer. Int J Gynecol Cancer 2015; 25 (04) 599-606
  • 3 Köbel M, Kalloger SE, Boyd N. et al. Ovarian carcinoma subtypes are different diseases: implications for biomarker studies. PLoS Med 2008; 5 (12) e232
  • 4 McGuire WP, Hoskins WJ, Brady MF. et al. Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer. N Engl J Med 1996; 334 (01) 1-6
  • 5 Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 2002; 20 (05) 1248-1259
  • 6 Cuylan ZF, Meydanli MM, Sari ME. et al. Prognostic factors for maximally or optimally cytoreduced stage III nonserous epithelial ovarian carcinoma treated with carboplatin/paclitaxel chemotherapy. J Obstet Gynaecol Res 2018; 44 (07) 1284-1293
  • 7 Azaïs H, Vignion-Dewalle AS, Carrier M. et al. Microscopic peritoneal residual disease after complete macroscopic cytoreductive surgery for advanced high grade serous ovarian cancer. J Clin Med 2020; 10 (01) 41
  • 8 Armstrong DK, Bundy B, Wenzel L. et al; Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 2006; 354 (01) 34-43
  • 9 Chang SJ, Bristow RE, Ryu HS. Impact of complete cytoreduction leaving no gross residual disease associated with radical cytoreductive surgical procedures on survival in advanced ovarian cancer. Ann Surg Oncol 2012; 19 (13) 4059-4067
  • 10 Lee SD, Park SC, Park JW, Kim DY, Choi HS, Oh JH. Laparoscopic versus open surgery for stage I rectal cancer: long-term oncologic outcomes. World J Surg 2013; 37 (03) 646-651
  • 11 Kitamura T, Qian BZ, Pollard JW. Immune cell promotion of metastasis. Nat Rev Immunol 2015; 15 (02) 73-86
  • 12 Alieva M, van Rheenen J, Broekman MLD. Potential impact of invasive surgical procedures on primary tumor growth and metastasis. Clin Exp Metastasis 2018; 35 (04) 319-331
  • 13 Abramovitch R, Marikovsky M, Meir G, Neeman M. Stimulation of tumour growth by wound-derived growth factors. Br J Cancer 1999; 79 (9-10): 1392-1398
  • 14 Lewis C, Murdoch C. Macrophage responses to hypoxia: implications for tumor progression and anti-cancer therapies. Am J Pathol 2005; 167 (03) 627-635
  • 15 Pantel K, Brakenhoff RH, Brandt B. Detection, clinical relevance and specific biological properties of disseminating tumour cells. Nat Rev Cancer 2008; 8 (05) 329-340
  • 16 Hogan BV, Peter MB, Shenoy HG, Horgan K, Hughes TA. Surgery induced immunosuppression. Surgeon 2011; 9 (01) 38-43
  • 17 Bates RC, Mercurio AM. Tumor necrosis factor-alpha stimulates the epithelial-to-mesenchymal transition of human colonic organoids. Mol Biol Cell 2003; 14 (05) 1790-1800
  • 18 Jing Y, Ma N, Fan T. et al. Tumor necrosis factor-alpha promotes tumor growth by inducing vascular endothelial growth factor. Cancer Invest 2011; 29 (07) 485-493
  • 19 Oosterling SJ, van der Bij GJ, Bögels M. et al. Anti-beta1 integrin antibody reduces surgery-induced adhesion of colon carcinoma cells to traumatized peritoneal surfaces. Ann Surg 2008; 247 (01) 85-94
  • 20 Holmgren L, O'Reilly MS, Folkman J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat Med 1995; 1 (02) 149-153
  • 21 Govaert KM, Emmink BL, Nijkamp MW. et al. Hypoxia after liver surgery imposes an aggressive cancer stem cell phenotype on residual tumor cells. Ann Surg 2014; 259 (04) 750-759
  • 22 Markman M, Bundy BN, Alberts DS. et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 2001; 19 (04) 1001-1007
  • 23 Wenzel LB, Huang HQ, Armstrong DK, Walker JL, Cella D. Gynecologic Oncology Group. Health-related quality of life during and after intraperitoneal versus intravenous chemotherapy for optimally debulked ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol 2007; 25 (04) 437-443
  • 24 Fujiwara K, Nagao S, Yamamoto K. et al. A randomized phase 3 trial of intraperitoneal versus intravenous carboplatin with dose-dense weekly paclitaxel in patients with ovarian, fallopian tube, or primary peritoneal carcinoma (a GOTIC-001/JGOG-3019/GCIG, iPoccTrial). Presented at: 2022 SGO Annual Meeting on Womens' Cancer; March 18–21, 2022; Phoenix, AZ. Abstract 241
  • 25 Goodman MD. ed. Regional Therapeutics for Advanced Malignancies. New Delhi: Jaypee Brothers Medical Publishers; 2012: 43-57
  • 26 Francis P, Rowinsky E, Schneider J, Hakes T, Hoskins W, Markman M. Phase I feasibility and pharmacologic study of weekly intraperitoneal paclitaxel: a Gynecologic Oncology Group pilot study. J Clin Oncol 1995; 13 (12) 2961-2967
  • 27 Loggie BW, Fleming RA, Geisinger KR. Cytologic assessment before and after intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Acta Cytol 1996; 40 (06) 1154-1158
  • 28 Di AGiorgio, De PIaco, De MSimone. et al. Cytoreduction (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: retrospective italian multicenter observational study of 511 cases. Ann Surg Oncol 2017; 24: 914-922
  • 29 Mercier F, Bakrin N, Bartlett DL. et al. PW Group, B-RW Group. Peritoneal carcinomatosis of rare ovarian origin treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a multi-institutional cohort from PSOGI and BIG-RENAPE. Ann Surg Oncol 2018; 25: 1668-1675
  • 30 van Driel WJ, Koole SN, Sikorska K. et al. Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 2018; 378 (03) 230-240
  • 31 Bakrin N, Bereder JM, Decullier E. et al; FROGHI (FRench Oncologic and Gynecologic HIPEC) Group. Peritoneal carcinomatosis treated with cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced ovarian carcinoma: a French multicentre retrospective cohort study of 566 patients. Eur J Surg Oncol 2013; 39 (12) 1435-1443
  • 32 Pavlov MJ, Kovacevic PA, Ceranic MS, Stamenkovic AB, Ivanovic AM, Kecmanovic DM. Cytoreductive surgery and modified heated intraoperative intraperitoneal chemotherapy (HIPEC) for advanced and recurrent ovarian cancer – 12-year single center experience. Eur J Surg Oncol 2009; 35 (11) 1186-1191
  • 33 Deraco M, Kusamura S, Virzì S. et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as upfront therapy for advanced epithelial ovarian cancer: multi-institutional phase-II trial. Gynecol Oncol 2011; 122 (02) 215-220