ADVANCED OVARIAN-CANCER - BRIEF INTENSIVE COMBINATION CHEMOTHERAPY AND 2ND-LOOK OPERATION

Abstract

The effects of brief intensive combination chemotherapy were evaluated in 59 patients with advanced epithelial ovarian cancer. Following surgery and before chemotherapy, 16 patients had limited residual cancer (tumor nodules 3 cm or less in diameter) and 43 had bulky disease (tumor nodules > 3 cm). Chemotherapy with hexamethylmelamine, cyclophosphamide or 5-fluorouracil, doxorubicin and cisplatin was given intensively. Myelosuppression was the most serious side effect, although gastrointestinal, neurologic and renal toxicity was also observed. Fifty-five of the 58 (95%) evaluable patients had either a partial clinical response or no clinically detectable tumor following therapy. Of these 55 patients, 45 underwent a 2nd-look surgical evaluation at 6 mo.; 17 of 45 patients (14 of 16 patients with limited residual disease and 3 of 29 with bulky disease) had no evidence of residual cancer and 9 patients had all known cancer resected. Sixteen of 17 patients who attained a complete response as judged by laparotomy remain in remission; median follow-up was 19 mo. following chemotherapy. This combination chemotherapy produced marked tumor regression as judged by a 2nd-look surgical evaluation; most patients who had limited residual disease have had all evidence of cancer eradicated. Longer observation is required to determine how many of these patients will remain continuously free of ovarian cancer.