BALTIMORE — Doctors have revived a 50-year-old method of delivering chemotherapy, reporting that infusions through the abdominal wall can add more than a year of life to patients with advanced cases of ovarian cancer.
On the down side, the treatment produced side effects so unpleasant that about half the patients stopped it early.
The report, published in today's New England Journal of Medicine, prompted an announcement by the National Cancer Institute that the technique confers "a significant survival benefit" and should be the preferred treatment for women with the advanced disease. The institute funded the study.
By delivering chemicals into the cavity where ovarian cancer tends to spread, an oncologist can concentrate medications on tumors that attach themselves to tissues such as the liver, diaphragm and bowel.
Researchers saw the survival benefit in women who received two standard chemotherapy drugs directly into the abdomen as well as through a vein.
"I think it's a major step forward," said Dr. Deborah Armstrong, an oncologist at Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center who led the study of 429 patients nationwide.
Patients receiving the combination treatment lived an average of 5 1/2 years, compared with four years among women receiving IV therapy alone.
The treatment was not easy for many patients. About half stopped it before the recommended 18 weeks because of side effects that included abdominal pain, numbness in the extremities and infections in tissues where the catheter was inserted.
Patients receiving the combination therapy had a "worse quality of life" during therapy, the authors said, though the quality of life was about the same for both groups a year after treatment.
Ovarian cancer tends to go undiscovered until it has spread to nearby tissues. At that point, it is extremely difficult to cure.
Doctors first infused chemotherapy drugs into the peritoneal cavity in the 1950s to treat colon cancer. Armstrong said the technique never died out, but as new drugs appeared, doctors felt more comfortable supplying them intravenously.
In recent years, eight studies -- including three in the U.S. -- have tested the abdominal treatment, or intraperitoneal infusion, combined with IV chemotherapy. All three of the U.S. studies showed the combination improved survival, although the most recent study produced the clearest benefits.
To qualify for the recent study, patients couldn't have tumors larger than a centimeter in diameter. Before the treatments, patients had surgery to remove as much tumor as possible.
Patients who qualified had plastic "ports" inserted under the skin below their rib cages, disks about the size of a half-dollar through which a needle could be inserted. All patients received two different medications -- paclitaxel and cisplatin.
In an editorial accompanying the journal article, Dr. Stephen A. Cannistra of Harvard Medical School, called the treatment "an important advance," but said doctors and patients must weigh the side effects before choosing it.