Modulation of intraperitoneal (IP) chemotherapy in ovarian cancer

Advanced epithelial ovarian cancer spreads predominantly within the peritoneal cavity, and this has prompted investigations into the delivery of chemotherapy directly into the space lined by visceral and parietal peritoneum. Intraperitoneal (IP) radionuclides, other radioimmunoconjugates, and bolus cytotoxic drugs administered in the presence of ascites were tested since the 1950s but seldom subject to rigorous clinical study. In 1978, Dedrick et al. developed the pharmacologic rationale for IP drug delivery: peripheral surfaces of small tumors within the peritoneal cavity could be exposed to higher cytotoxic drug concentrations for longer durations of time than could be safely attained with systemic drug administration (1). Further, the central portions of the tumor continue to be exposed to drug via systemic absorption from the peritoneal cavity—thus, the subsequent designation in the literature of two-way chemotherapy