Treatment of advanced ovarian cancer with surgery, chemotherapy, and consolidation of response by whole-abdominal radiotherapy

Abstract

Between April 1981 and June 1985, 195 patients with ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) Stages IIB, IIC, III, and IV, entered a trial that consisted of surgery and chemotherapy with cisplatin (P) and melphalan (PAM) with or without hexamethylmelamine (HexaPAMP or PAMP regimens) every 4 weeks for 6 cycles. Because the intent was to study the outcome by treatment after evaluation of first-line chemotherapy, patients were evaluable only if the response was assessed by a second-look operation or if measurable disease progression was documented. One hundred fifty-eight patients (81%) were evaluable for response. Forty-five (28%) achieved pathologically confirmed complete remissions (pCR), and 24 of these patients received whole-abdominal radiation (WAR) for consolidation of response. Five patients with complete remission after WAR relapsed, as did nine of the 21 with complete remission who had not undergone WAR. The 3-year time to progression percentage (TTP +/- SE) from second-look operation was 70% +/- 7% for all patients who achieved pCR, 83% +/- 8% for those who received WAR, and 49% +/- 15% for those who did not receive WAR (this was not a randomized comparison). The 3-year TTP percentage for the 49 partial responders was 21% +/- 6%, identical for the 19 who had WAR and the 30 who had no radiation therapy. Additional or alternative methods for consolidation of pCR are needed since patients continue to relapse despite optimal initial response to therapy.

Treatment of ovarian cancer with surgery, short-course chemotherapy and whole abdominal radiation

“…The overall response rate was 67% with 26% of the patients achieving pCR. This is comparable to other data in the literature for cisplatin-based chemotherapies delivered over 6-12 cycles [4,13]. Sixty-seven percent of the responses were pathologically evaluated.…”

“…In the previous SAKK trial [4], the actuarial 3-year time to progression after second-look operation for patients who achieved complete remission and underwent radiotherapy for consolidation of response was 83% vs. 49% for patients without radiation.…”

“…Cisplatin and melphalan are equally effective. In a large single-arm study conducted by the SAKK (Swiss Group for Clinical Cancer Research), a pathological response rate of 59% was achieved with 6 cycles of this combination [4].…”

“…The open field technique became the standard approach and proved to be equally effective but less toxic and easier to apply than the moving-strip [6]. Several single-arm studies of sequential multimodality therapy including chemotherapy, second-look surgery and radiotherapy [4,[7][8] have been published since the report of Dembo. It remains difficult to draw conclusions from these non-randomized studies.…”

High-dose melphalan-based chemotherapy and autologous stem cell transplantation after second look laparotomy in patients with chemosensitive advanced ovarian carcinoma: long-term results

“…Other studies have evaluated salvage strategies for patients with positive second-look surgery and to date long-term results are similar to ours with 5-year survivals inferior to 15% and a median less than 18 months. 22 They have been reported with several conventional chemotherapies, 23 intraperitoneal chemotherapy and/or immunotherapy with interferon, 24,25 whole abdominal radiation therapy 23,26,27 and even HDC and HSCS. 16,28,29 The poor prognosis of our 13 patients along with the abovementioned observations implies that no presently known salvage therapy is clearly superior to any other in this situation.…”