1;Intraperitoneal Therapy for Ovarian Cancer;2 1.1;Acknowledgment;4 1.2;Contents;5 1.3;1: Introduction;7 1.3.1;References;11 1.4;2: Current Chemotherapy of Ovarian Cancer;13 1.4.1;2.1 Trials that Define Primary Treatment;13 1.4.2;2.2 Optimal Integration of Taxanes;15 1.4.3;2.3 Integration of a Third Cytotoxic Agent;16 1.4.4;2.4 New Approaches Targeting the Mitotic Apparatus;17 1.4.5;2.5 Development of Alternative Cytotoxic Agents;18 1.4.6;2.6 Biologic Principles with an Impact on Primary Therapy;18 1.4.7;2.7 Targeting Angiogenesis;21 1.4.8;2.8 Chemotherapy Resistance;21 1.4.9;2.9 Synthetic Lethal Strategies;23 1.4.10;2.10 Discussion;24 1.4.11;References;25 1.5;3: Principles of Intraperitoneal Chemotherapy;32 1.5.1;3.1 Introduction;32 1.5.2;3.2 Rationale for the Delivery of Antineoplastic Agents by the IntraperitonealRoute as a Treatment for Intraperitoneal Malignan;32 1.5.2.1;3.2.1 Anatomic Location of the Cancer;32 1.5.2.2;3.2.2 General Physiology of the Peritoneal Cavity Relevant for Intraperitoneal Antineoplastic Drug Delivery;33 1.5.2.3;3.2.3 Evidence of Concentration-Dependent Biological Activity of an Antineoplastic Agent;34 1.5.3;3.3 Limitations of Intraperitoneal Antineoplastic Drug Delivery;35 1.5.3.1;3.3.1 Local Toxicity of Antineoplastic Agents;35 1.5.3.2;3.3.2 Adequacy of Drug Distribution;35 1.5.3.3;3.3.3 Limited Direct Penetration of Antineoplastic Agents into Tumor Masses;36 1.5.3.4;3.3.4 Importance of Drug Delivery by Capillary Flow;36 1.5.3.5;3.3.5 Other Relevant Issues Defining the Use of Intraperitoneal Chemotherapy;37 1.5.4;3.4 Conclusion;37 1.5.5;References;38 1.6;4: Intraperitoneal Chemotherapy:Phase III Trials;41 1.6.1;4.1 Introduction;41 1.6.2;4.2 SWOG 8501/GOG 0104/EST 3885;42 1.6.3;4.3 GOG 0114/SWOG 9227/ECOG-GO 114;44 1.6.4;4.4 GOG 0172;46 1.6.5;4.5 Future Phase III IP Trials;51 1.6.6;4.6 Conclusion;52 1.6.7;References;53 1.7;5: Criteria for Using Intraperitoneal (IP) Chemotherapy for Advanced Ovarian Cancer;55 1.7.1;5.1 Frontline Therapy;55 1.7.1.1;5.1.1 Impact of the Size of Residual Disease;55 1.7.1.2;5.1.2 Impact of Chemical Debulking Prior to IP Therapy;56 1.7.1.3;5.1.3 Impact of Disease Stage;57 1.7.2;5.2 Consolidation Therapy;57 1.7.2.1;5.2.1 Consolidation Therapy for Patients with no Residual Disease;57 1.7.2.2;5.2.2 Consolidation Therapy for Patients with Minimal Residual Disease;58 1.7.2.3;5.2.3 Impact of Retroperitoneal Disease;58 1.7.2.4;5.2.4 Impact of Stage IV Disease;59 1.7.2.5;5.2.5 Presence of Adhesions;60 1.7.3;5.3 Conclusions;60 1.7.4;References;61 1.8;6: Selection and Placement of Intraperitoneal Catheters for IP Chemotherapy for Ovarian Cancer;63 1.8.1;6.1Introduction;63 1.8.2;6.2Background on IP Catheters;65 1.8.3;6.3 Peritoneal Catheter Placement at Primary Surgery for Presumed Ovarian Cancer;68 1.8.4;6.4 Radical Surgical Procedures;68 1.8.5;6.5 Choice of Device and Catheter;69 1.8.6;6.6 Technique for Placement at Laparotomy;70 1.8.7;6.7 Prevention of Catheter Failures;71 1.8.8;6.8 Prevention of Adhesions;75 1.8.9;6.9 Delayed Insertion of Peritoneal Catheter;75 1.8.10;6.10 Interventional Radiology Placement;76 1.8.11;6.11 Removal of the Catheter;77 1.8.12;6.12 Conclusions;77 1.8.13;References;78 1.9;7: Selection of Drugs for Intraperitoneal Chemotherapy for Ovarian Cancer;81 1.9.1;7.1 Introduction;81 1.9.2;7.2 Pharmacologic Principles of Intraperitoneal Therapy;82 1.9.3;7.3 Relative Clearances and First Pass Metabolism;82 1.9.4;7.4 Tumor Penetration;83 1.9.5;7.5 Intraperitoneal Drug Distribution;85 1.9.6;7.6 Principles for the Selection of Drugs for Intraperitoneal Administration;85 1.9.7;7.7 Pharmacokinetics of Intraperitoneally Administered Cisplatin, Carboplatin, and Paclitaxel;86 1.9.8;7.8 Neutralizing Agents;88 1.9.9;7.9 Strategies for Improving Drug Penetration;89 1.9.10;References;90 1.10;8: Administration Guidelines for Intraperitoneal Chemotherapy for Ovarian Cancer;93 1.10.1;8.1 Introduction;93 1.10.2;8.2 Selection of Patients for IP Chemotherapy;93 1.10.3;8.3 Positio