Chemotherapeutic and surgical induction of pathological complete remission and whole abdominal irradiation for consolidation does not enhance the cure of stage III ovarian carcinoma.

Abstract

Thirty-eight patients with stage III ovarian carcinoma were treated with a protocol consisting of an initial phase of induction of remission with cyclophosphamide, hexamethylmelamine, doxorubicin, and cisplatin (CHAD) combination chemotherapy and a second laparotomy for resection of residual tumors, followed by a consolidation phase with curative doses of whole abdominal radiation. Six patients (16%) had stage IIIA disease, ten (26%) IIIB, and 22 (58%) had stage IIIC disease. All patients received three to 14 courses of CHAD chemotherapy with a clinical response rate (complete [CR] and partial [PR]) of 91%. Thirty-three patients underwent the second operation. In 14 patients no residual tumor was found, and in another 11 residual tumors found were totally resected. Thus, 25 of 33 (76%) were classified as in pathological complete remission (PCR) after this operation. Whole abdominal irradiation was well tolerated, although 12 of 29 (42%) of the irradiated patients required more than a 2-week interruption of the treatment course because of leukopenia and/or thrombocytopenia. The actuarial 5-year survival and disease-free survival rates for the whole group were 27% and 17%, respectively, and for the 29 patients who received the complete sequence of the prescribed protocol treatments, 35% and 20%, respectively. A univariate analysis of clinical parameters showed that inherent biological features, such as histology and grade, were the most dominant factors affecting prognosis, and that neither the aggressive surgical approach employed, nor the high-dose whole abdominal irradiation, significantly affected the outcome. The long-term results suggest that although our combined modality protocol was well tolerated, it failed to enhance the cure of stage III ovarian carcinoma. The possible biological and therapeutic vectors affecting this outcome are discussed.

Second-look laparotomy for epithelial ovarian cancer: A reappraisal

“…No comparison was made to an untreated control group. Fuks et al [38] reported no advantage to whole abdominal radiation in 25 patients with negative findings at SLL.…”

Consolidation treatment of advanced (FIGO stage III) ovarian carcinoma in complete surgical remission after induction chemotherapy: A randomized, controlled, clinical trial comparing whole abdominal radiotherapy, chemotherapy, and no further treatment

“…Consolidation radiotherapy has been evaluated in a number of reports during the past decade (5,(10)(11)(12)14,(26)(27)(28)(29)(30)(31)(32)(33) . Negative outcomes are reported in a number of these studies (5,(26)(27)(28)31,33) .…”

“…Negative outcomes are reported in a number of these studies (5,(26)(27)(28)31,33) . More promising results are presented by others (10)(11)(12)14,29,30,32) , even though most series are small and not randomized.…”

“…Whole abdominal radiotherapy has also been used as consolidation treatment after primary surgery and induction chemotherapy (5,(26)(27)(28)(29)(30)(31)(32) . Prerequisites for successful treatment with minimal morbidity were proposed by Thomas in 1993 (10) .…”

“…Acute hematologic toxicity (27,32) and delayed intestinal side effects are reported to be significant problems in some trials. A lack of randomized and controlled trials has prevented drawing firm conclusions about the value of radiotherapy for this group of patients (31) . In a small number of trials, radiotherapy and chemotherapy as consolidation treatment have been compared with each other (28,30,33) .…”