An ovarian cancer treatment protocol that had fallen out of favor over the past 20 years is re-emerging after a recent study found that the little-used method can extend a patients life by more than a year.


Thats encouraging news for sufferers of ovarian cancer, which kills within five years 95 percent of the women who are diagnosed with the disease, says Dr. Melanie Bergman, a gynecologic oncologist at Cancer Care Northwest PS, of Spokane.


The treatment, called intraperitoneal chemotherapy, involves administering drug doses directly into a patients abdomen via a small catheter, in conjunction with giving some doses intravenously. In recent years, ovarian cancer patients have received intravenous chemotherapy exclusively, Bergman says.


Bergman and fellow gynecologic oncologist Dr. Elizabeth Grosen, also of Cancer Care Northwest, began introducing the re-emerging treatment option to patients here after a study that came out in January showed patients who received the intraperitoneal drug protocol have a longer lifespan.


The disease still came back, Bergman says. The treatment, however, allows their progression-free survival and overall survival to increase.


According to the study, published in the New England Journal of Medicine, overall survival, which is the duration between when a patient is diagnosed with ovarian cancer and when she dies, was 65 months on average for women who received intraperitoneal chemotherapy, compared with 49 months for women who had received intravenous chemotherapy exclusively.


Progression-free survival, which is the period between when a cancer treatment is completed and when the disease returns, increased to almost 24 months on average, compared with 18 months.


Grosen says, however, that while she now will administer chemotherapy into the abdomen of ovarian cancer sufferers more frequently, its unclear whether she will continue to use the precise drug regimen used in the study.


Drugs used in the study were more toxic than others used in chemotherapy, and women suffer more severe side effects from the more powerful drugswhich is one of the reasons oncologists began shying away from intraperitoneal chemotherapy in the 1980s. Those side effects include increased nerve damage, nausea, and a greater degree of fatigue. Talk in some gynecologic oncology circles, Grosen says, is that similar results can be achieved by administering through the abdomen drugs that dont cause the same harsh side effects.


The results of the study are black and white, Grosen says. How we go from here to treating patients is more complicated.


Still, Bergman says, if given the choice, most patients would opt to go through the tougher treatment cycle in order to live longer.


Every patient of mine has said yes so far, she says.


Bergman says a patient goes through six treatment cycles over the course of about 4 1/2 monthsone treatment cycle lasts three weeks, with three drug doses given within that cycle.


To be able to administer intraperitoneal chemotherapy, a physician implants in the side of a patients torso a metal port attached to a catheter that extends from the port into the patients abdominal area. Drugs injected into the catheter via the port travel into the abdominal area.


Bergman says the port and catheter can be installed at the same time surgery is performed to remove the cancerous tissue. If the cancer has spread to a patients intestines and a bowel resection is necessary, though, the port and catheter likely will be installed after the resection has healed, she says.


For the chemotherapy to be successful, disease within a patient must be almost completely removed, or whats called optimally debulked, Bergman says. In some cases, she says, the disease has progressed to the point where it cant be optimally debulkedin those instances, the cancer has spread to other organs that cant be removed.


With intraperitoneal chemotherapy, Grosen says, drugs not only fight cancer by coming into contact with the affected areas, but also by being absorbed into the tissue, enabling them to kill cells below the tissues surface.


That form of chemotherapy also is used to fight colon cancer in some instances, she says.


Bergman says intraperitoneal chemotherapy had been used commonly in the 1960s and 1970s, before intravenous chemotherapy became the preferred method, in the absence of data that showed patients live longer when receiving drugs through the abdomen.


Grosen says, Most of us were giving IV chemo because its much easier. You dont want to put people through this without good data.


In addition to the harsh side effects, a patient and physician must monitor the port to make sure that it remains in place properly and that the area around it doesnt get infected.


Contact Linn Parish at (509) 344-1266 or via e-mail at linnp@spokanejournal.com.