Cindy Pakalnis' chemotherapy regimen last year was grueling, but doctors today are saying it gives her and other women with advanced ovarian cancer the best chance for survival.

On Wednesdays, Ms. Pakalnis would take a day off from work and go to Magee-Womens Hospital, where chemotherapeutic drugs would be infused into her abdomen. She would work the next two days but, by Saturday, she would start suffering bone and muscle pain so intense that she couldn't go back to work until the following Wednesday.

And then she would repeat the process three weeks later.

Ms. Pakalnis, 50, of Marshall, tolerated the regimen reasonably well. In a study reported in today's New England Journal of Medicine, for instance, only two out of every five women in the study were able to complete all six cycles of this intra-abdominal, or intraperitoneal, chemotherapy.

But those who received the intra-abdominal chemotherapy, after having surgery to reduce the size of their tumors, survived 16 months longer than those patients who received just intravenous chemotherapy -- 66 months vs. 50 months.

The improvement was so significant that the National Cancer Institute yesterday issued an announcement urging physicians to offer the therapy to all women with advanced ovarian cancer.

"This is probably a major breakthrough," said Dr. Robert Edwards, director of research at Magee-Womens Gynecologic Cancer Program and Ms. Pakalnis' physician.

Ovarian cancer has few symptoms in its early stages, so 40 to 50 percent of patients are already at an advanced stage by the time they are diagnosed and only 10 to 14 percent of these women with advanced cancer survive more than five years, he said.

Standard therapy for advanced ovarian cancer has been outpatient intravenous therapy with Taxol and carboplatin. The new therapy includes intravenous as well as intra-abdominal infusions of Taxol and cisplatin. The intra-abdominal infusions allow the chemo to stay in the system longer, Dr. Edwards said.

Many women are able to continue work while undergoing intravenous chemotherapy, but many don't feel well enough to work for the duration of the intra-abdominal, he said.

Ms. Pakalnis said she is happy with her decision, noting a CT scan last summer showed no signs of tumor and blood tests after she completed her chemotherapy this fall showed levels of cancer antigens well within the normal range.

"2006 is going to be a good year," she predicted, noting she and her husband, John, have booked a Mediterranean cruise. "A great year."