Toxicity Of Intraperitoneal Chemotherapy In Advanced Ovarian Cancer: A Meta Analysis

【Background】It has been 30 years since intraperitoneal chemotherapy was used in the treatment of ovary cancer.Intraperitoneal(IP) chemotherapy has a clear survival advantage in patients with advanced ovarian cancer,but the high rate of complications has discouraged widespread acceptance.Some scholars questioned whether the absolute benefit of IP chemotherapy warranted the increase in toxicity and reductions in quality of life. Recently in many clinical trials doses of cisplatin in IP group were larger than that inⅣgroup,which may lead to the misunderstanding that systemic toxicity increases in intraperitoneal chemotherapy。【Objectives】The study discussed chemo-related systemic toxicity of intraperitoneal chemotherapy in patients with advanced ovarian cancer,to make a better understanding of intraperitoneal chemotherapy,and to provide statistical evidence for the improvement of IP chemotherapy scheme.【Methods】All the domestic and abroad articles about intraperitoneal chemotherapy in advanced ovarian cancer were collected,which then were retrieved,evaluated,selected, checked and analyzed.6 articles were divided into two groups according to doses of cisplatin(IP＞Ⅳand IP=Ⅳ),and every single toxicity was measured by meta analysis respectively. 【Results】Total six articles and 1692 patients were included.Meta analysis on the selected literature was conducted by means of Review Manager 4.2 software.The results is:＜1＞when the doses of cisplatin was larger in IP group than that inⅣgroup,IP group versusⅣgroup:leucopenia RR 1.21,95%CI[1.11,1.32],P＜0.0001;thrombocytopenia RR 2.46,95%CI[1.22,4.99],P=0.01(＜0.05);gastrointestinal event RR 1.85,95%CI[1.50, 2.28],P＜0.00001;AnemiaRR 0.65,95%CI[0.29,1.47],P=0.30(＞0.1); NephrotoxicityRR3.04,95%CI[1.38,6.69],P=0.006(＜0.05);Neurotoxicity R 1.92, 95%CI[1.26,2.92],P=0.003(＜0.05)。＜2＞when the doses of cisplatin was equal in both IP group andⅣgroup,IP group versusⅣgroup:leucopeniaRR 0.84,95%CI[0.69, 1.01],P=0.06,(＞0.05);thrombocytopeniaRR 0.85,95%CI[0.49,1.48],P=0.56(＞0.1); AnemiaRR 1.07,95%CI[0.80,1.42],P=0.66(＞0.1);NeurotoxicityRR 0.55,95%CI[0.35, 0.84],P=0.006(＜0.05)。【Conclusions】This study shows that:difference between incidence of leukopenia,thrombocy-topenia,anemia in IP group and that inⅣgroup was not significant,while incidence of neurotoxcity was significantly lower in IP group than that was inⅣgroup when doses of cisplatin were equal.Incidence of toxcity(especially neurotoxcity and nephrotoxity) was higher in IP group except anemia,given the condition that dose of cisplatin was larger in IP group.Our study shows that intraperitoneal chemotherapy itself did not increase but might reduce some chemo-related systemic toxicity in advanced ovarian cancer.In previous study,increased incidence rate of chemo-related systemic toxicity caused by intraperitoneal chemotherapy was raised in the condition that doses of cisplatin was larger in IP group than that was inⅣgroup.