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Cytotoxicity of Hypo-osmolar Lavage Fluid on Ovarian Cancer Cells In vitro

Elena M Paulus, Joseph T Santoso, Michelle M Sims, Jashmin K Patel, Lawrence M Pfeffer

Objective: Ovarian cancer is difficult to diagnose early and many patients present with advanced disease. The presence of exfoliated ovarian cancer cells in the peritoneal cavity after debulking surgery is a poor prognostic indicator. Sterilization of the peritoneum during surgery may have clinical benefit in reducing tumor burden. Several studies have evaluated osmotic cytotoxicity in gastrointestinal and genitourinary cancers with varied results. We studied the cytotoxic effect of lavage fluids of differing osmolarities against multiple ovarian cancer cell lines (SKOV3, OV90, and OVCAR3) in vitro.
Methods: Cells were treated for either 10 minutes or 30 minutes with water, or 5 mOsm, 10 mOsm, 50 mOsm, 100 mOsm, 200 mOsm, 280 mOsm NaCl (dilutions in water), and PBS. After 24 hours, surviving cells were enumerated in a Coulter Counter.
Results: All 3 ovarian cancer cell lines were lysed progressively as lavage osmolarity was reduced (p<0.01). For the OVCAR3 ovarian cancer cells, lavage for 30 min resulted in greater cell cytotoxicity for lavage with the water, 5, 10, 50, and 200 mOsm saline when compared to lavage for 10 min. For the OV90 cancer cell line, lavage for 30 min resulted in greater cell cytotoxicity for the water, 5, and 10 mOsm saline lavages. In the SKOV3 ovarian cancer cell line, only lavage for the 30 min water had cytotoxicity.
Conclusions: Since ovarian cancer uniquely resides in the peritoneal cavity, this anatomic feature allows concentrated washing to directly target these cancer cells residing in the peritoneal cavity. Hypo-osmolar treatment was found to be most effective in lysing ovarian cancer cell lines in vitro.