Intraoperative, intraperitoneal chemotherapy in advanced gynecological malignancies. A report on the acceptability of a new therapeutic regimen.

Considering that in gynecologic carcinomas cells and cellular tumor parts can be left in the abdominal space leading to an increased growth of recurrences due to a change in the cell-kinetic situation, 19 patients with advanced gynecologic tumors were treated locally with 15 mg mitomycin or 30 mg (40 mg) mitoxantrone dissolved in 1000 mg saline before the operation was completed. The course of disease after intraoperative, intraperitoneal chemotherapy given in addition to the usual chemo- or radiotherapeutic regimen was as follows: in 14 patients assessed up to now, a NED state was achieved 4 times, while there was a partial remission in 2 cases and a SD situation in one. In two women there was progression. In the group with recurrent treatment (5 women), a further progressive course was observed in 4 patients. In one case there was a partial remission. With mitoxantrone serum levels between in 10-60 ng/ml, two subilium situations and postoperative nausea were noticed as side-effects. Among the changes noted in the chemical laboratory, there was one leukopenia grade IV and five grade III-leukopenias as well as various intermittent alterations of the liver values and electrocytes. One case of wound healing disturbances with prolapsed small intestine convolution in the wound area was observed in the tumor growth developing in the abdominal wall. The side-effects of the intraoperative and intraperitoneal therapy with cytostatics were generally acceptable. Given the observed courses of the disease, a continuation of the intraperitoneal therapy form aimed against postoperative residual and aggressively growing tumor cells would appear to be justifiable.