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Ovarian cancer is the leading cause of death from gynecologic cancer and the fifth cause of cancer deaths in women in developed countries (Yancik, 1993; Cannistra, 1993). The number of deaths seems to increase the last few years. More than 70% of the patients with ovarian cancer have advanced disease at the time of initial diagnosis because they remain asymptomatic in early stages (Roberts, 1996). Ovarian cancer is the most frequent intraceolomic malignancy presenting with peritoneal spread. In the past debulking surgery combined with systemic chemotherapy offered long-term survival in less than 10% of the patients (Smith & Day, 1979). The standard treatment of advanced ovarian cancer is cytoreductive surgery followed by systemic chemotherapy (Hacker et al, 1983; Neijt et al, 1991; Hoskins et al, 1992). Despite systemic chemotherapy based on platinum and taxanes 5 and 10-year survival rate do not exceed 20% and 10% respectively because the majority of the patients develop recurrence (Mc Guire & Ozols, 1998; Piccart et al, 2000). The disease remains characteristically confined to the peritoneal surfaces for most of its natural course (Bergmann, 1996). Surgical resection of the tumor may not be complete and microscopic or even macroscopic residual tumor may be left behind. In these situations the intraperitoneal route of administration of cytostatic drugs is a logical approach. Patients with diseases that have similar biological behavior to ovarian cancer are offered significant survival benefit when they are treated with perioperative intraperitoneal chemotherapy integrated in cytoreductive surgery. In pseudomyxoma peritonei (Sugarbaker, 2006), peritoneal sarcomatosis (Rossi et al, 2004), peritoneal mesothelioma (Yan et al, 2007), colorectal cancer with peritoneal dissemination (Elias et al, 2009; Mahteme et al, 2004; Verwaal et al, 2008), as well as in gastric cancer with peritoneal carcinomatosis (Yonemura et al, 1996; Yu et al, 1998) survival is improved with this treatment strategy. The last two decades the method has been used in ovarian cancer with promising results.

Combined Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for the Treatment of Advanced Ovarian Cancer