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Neoadjuvant chemotherapy for advanced ovarian cancer
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Citations from the literature /Inr. J. Gynecol. Obstet. 47 (1994) 315-323
vasive cervical cancer stage IB through stage IIIB with metastasis topara-aortic nodes were entered in this study. Five patients were excluded. Of 17 remaining evaluable patients, 5 (29%) were stage IB, 6 (35%) were stage IIB, and 6 (35%) were stage IIIB. Four (24%) had grade I, 5 (29%) had grade 2, and 8 (47%) had grade 3 tumor. Lymph node metastases were microscopic in 8 (47%) and macroscopic in 9 (53%) patients. All patients received 2 courses of chemotherapy concomitant with radiation as a sensitizer. They were randomized to receive either cisplatin (regimen A) or combination of cisplatin with 5FU infusion (regimen B). This was followed by maintenance chemotherapy with cisplatin for a maximum of IO additional courses. Of 17 patients, 7 (41%) received 4-6 courses, 4 (24%) received 6-8 courses, and 6 (35%) received 8-10 courses of maintenance chemotherapy. For extended-field radiation, a panhandle technique was used. External radiation therapy was delivered via IO or 18 MeV linear accelerator photons, followed by I or 2 intracavitary cesium applications. Patients were followed up 8-103 months (median 21 months). Progressionfree interval (PFI) for all patients was 5-103 months (median 18 months). Patients with microscopic metastasis topara-aortic nodes had median PFI of 26.5 months compared to 14 months in those with macroscopic nodal metastasis. Seven of 17 patients (41%) are alive from 17 to 103 months with median survival of 32 months. Overall survival for the entire group was 8-103 months (median 21 months). Median survival for patients with microscopic and macroscopic nodal metastasis was 30 and 21 months, respectively. Two- and five-year survival for the entire group was 35 and 12%. respectively. The survival with microscopic metastasis to para-aortic nodes was 50 and 12%compared to survival of 22% at 2 years and 11% at 5 years, respectively in those with macroscopic nodal metastasis. There was no significant difference between regimen A and B for local disease control. Maintenance chemotherapy with cisplatin did not appear to significantly improve the 5-year survival. Distant metastases were the predominant sites of failure.
Complications of tke ileocolonic continent urinary reservoir (Miami pouch) Penalver M.; Donato D.; Sevin B.-U.; Bloch W.E.; Alvarez W.J.; Averette H. USA GYNECOL ONCOL 1994 52/3 (360-364) Urinary diversion via the continent ileocolonic reservoir has been performed at our institution since February 1988. During a 4-year period, 39 patients have received this procedure as an alternative to other forms of cutaneous urinary diversion at the time of exenteration. We analyze our data in terms of early and late (beyond 6 weeks) complications resulting directly from the operation or from this form of urinary diversion. A-total of 18 patients (46%) suffered early complications resulting in an operative mortality rate of 7% (3 of 39 patients). One or more late complications occurred in six patients (I 5%). Only one patient required reoperation for a postoperative complication. With ongoing experience, problem areas have been identified that have led us to make modifications in technique. We review our experience with the incidence of early and late complications in terms of management and ultimate prevention.
Neoadjuvantchemotherapyfor advanced ovarian cancer Schwartz P.E.; Chambers J.T.; Makuch R. USA GYNECOL ONCOL 1994 53/l (33-37) The purpose of this study was to compare the survival of women with clinical, radiologic, and histologic findings compatible with advanced ovarian cancer who were treated with neoadjuvant chemotherapy to that of a group of women with FIG0 stage IIIC (suboptimal debulking) and stage IV epithelial ovarian cancers treated with the same chemotherapy. Eleven women with physical, radiologic, and histologic lindings compatible with advanced ovarian cancer (median age, 73 years) treated with neoadjuvant carboplatin and cyclophosphamide chemotherapy were compared to 18 women (median age, 60 years) who had stage 111 and suboptimal surgical cytoreduction (>2 cm residual tumor, 13 patients) or stage IV (5 patients) ovarian cancer followed by the same chemotherapy. The progression-free survival for the 11 women receiving neoadjuvant chemotherapy was 9.1 months which was not statistically different from the 8.5 months progression-free sur-
Second-luok laparotomy in ovarian germ cell tumors: The Gyaecologic Oncology Group experience Williams S.D.; Blessing J.A.; DiSaia P.J.; Major F.J.: Ball H.G. 111;Liao S.-Y. USA GYNECOL ONCOL 1994 5213(287-291) The Gynecologic Oncology Group (GOG) experience with second-look laparotomy in malignant ovarian germ cell tumors is reviewed. All patients in this study were enrolled prospectively on one of three protocols that employed relatively brief cisplatin-based chemotherapy after initial surgical staging and cytoreduction. Forty-live surgical procedures were done in patients who received three courses of cisplatin-based adjuvant therapy after complete tumor resection. Findings were no tumor or mature teratoma in 43; 2 patients had immature teratomas. One of the latter patients received further chemotherapy and one did not. Both of these patients and 44 of the total are disease free. Seventy-two patients were treated with similar chemotherapy for advanced incompletely resected tumor. Forty-eight of these patients did not have teratoma ele-
viva1 for the 18 women with suboptimally debulked stage IIIC or stage IV disease (P = 0.98). The overall survival was not significantly different (P = 0.26). Neoadjuvant-treated patients tended to tolerate chemotherapy better as none required dose reduction for bone marrow suppression, while 6 of 18 conventionally treated patient required dose reductions. In conclusion, neoadjuvant chemotherapy appears to be an effective means of palliating women with clinical, radiological, and histologic findings compatible with advanced ovarian cancer. A prospective study is necessary in which women with findings compatible with advanced ovarian cancer that is not likely to be effectively cytoreduced surgically are randomized to either undergo cytoreductive surgery followed by chemotherapy or receive neoadjuvant chemotherapy.
Citations from the literature /Inr. J. Gynecol. Obstet. 47 (1994) 315-323
vasive cervical cancer stage IB through stage IIIB with metastasis topara-aortic nodes were entered in this study. Five patients were excluded. Of 17 remaining evaluable patients, 5 (29%) were stage IB, 6 (35%) were stage IIB, and 6 (35%) were stage IIIB. Four (24%) had grade I, 5 (29%) had grade 2, and 8 (47%) had grade 3 tumor. Lymph node metastases were microscopic in 8 (47%) and macroscopic in 9 (53%) patients. All patients received 2 courses of chemotherapy concomitant with radiation as a sensitizer. They were randomized to receive either cisplatin (regimen A) or combination of cisplatin with 5FU infusion (regimen B). This was followed by maintenance chemotherapy with cisplatin for a maximum of IO additional courses. Of 17 patients, 7 (41%) received 4-6 courses, 4 (24%) received 6-8 courses, and 6 (35%) received 8-10 courses of maintenance chemotherapy. For extended-field radiation, a panhandle technique was used. External radiation therapy was delivered via IO or 18 MeV linear accelerator photons, followed by I or 2 intracavitary cesium applications. Patients were followed up 8-103 months (median 21 months). Progressionfree interval (PFI) for all patients was 5-103 months (median 18 months). Patients with microscopic metastasis topara-aortic nodes had median PFI of 26.5 months compared to 14 months in those with macroscopic nodal metastasis. Seven of 17 patients (41%) are alive from 17 to 103 months with median survival of 32 months. Overall survival for the entire group was 8-103 months (median 21 months). Median survival for patients with microscopic and macroscopic nodal metastasis was 30 and 21 months, respectively. Two- and five-year survival for the entire group was 35 and 12%. respectively. The survival with microscopic metastasis to para-aortic nodes was 50 and 12%compared to survival of 22% at 2 years and 11% at 5 years, respectively in those with macroscopic nodal metastasis. There was no significant difference between regimen A and B for local disease control. Maintenance chemotherapy with cisplatin did not appear to significantly improve the 5-year survival. Distant metastases were the predominant sites of failure.
Complications of tke ileocolonic continent urinary reservoir (Miami pouch) Penalver M.; Donato D.; Sevin B.-U.; Bloch W.E.; Alvarez W.J.; Averette H. USA GYNECOL ONCOL 1994 52/3 (360-364) Urinary diversion via the continent ileocolonic reservoir has been performed at our institution since February 1988. During a 4-year period, 39 patients have received this procedure as an alternative to other forms of cutaneous urinary diversion at the time of exenteration. We analyze our data in terms of early and late (beyond 6 weeks) complications resulting directly from the operation or from this form of urinary diversion. A-total of 18 patients (46%) suffered early complications resulting in an operative mortality rate of 7% (3 of 39 patients). One or more late complications occurred in six patients (I 5%). Only one patient required reoperation for a postoperative complication. With ongoing experience, problem areas have been identified that have led us to make modifications in technique. We review our experience with the incidence of early and late complications in terms of management and ultimate prevention.
Neoadjuvantchemotherapyfor advanced ovarian cancer Schwartz P.E.; Chambers J.T.; Makuch R. USA GYNECOL ONCOL 1994 53/l (33-37) The purpose of this study was to compare the survival of women with clinical, radiologic, and histologic findings compatible with advanced ovarian cancer who were treated with neoadjuvant chemotherapy to that of a group of women with FIG0 stage IIIC (suboptimal debulking) and stage IV epithelial ovarian cancers treated with the same chemotherapy. Eleven women with physical, radiologic, and histologic lindings compatible with advanced ovarian cancer (median age, 73 years) treated with neoadjuvant carboplatin and cyclophosphamide chemotherapy were compared to 18 women (median age, 60 years) who had stage 111 and suboptimal surgical cytoreduction (>2 cm residual tumor, 13 patients) or stage IV (5 patients) ovarian cancer followed by the same chemotherapy. The progression-free survival for the 11 women receiving neoadjuvant chemotherapy was 9.1 months which was not statistically different from the 8.5 months progression-free sur-
Second-luok laparotomy in ovarian germ cell tumors: The Gyaecologic Oncology Group experience Williams S.D.; Blessing J.A.; DiSaia P.J.; Major F.J.: Ball H.G. 111;Liao S.-Y. USA GYNECOL ONCOL 1994 5213(287-291) The Gynecologic Oncology Group (GOG) experience with second-look laparotomy in malignant ovarian germ cell tumors is reviewed. All patients in this study were enrolled prospectively on one of three protocols that employed relatively brief cisplatin-based chemotherapy after initial surgical staging and cytoreduction. Forty-live surgical procedures were done in patients who received three courses of cisplatin-based adjuvant therapy after complete tumor resection. Findings were no tumor or mature teratoma in 43; 2 patients had immature teratomas. One of the latter patients received further chemotherapy and one did not. Both of these patients and 44 of the total are disease free. Seventy-two patients were treated with similar chemotherapy for advanced incompletely resected tumor. Forty-eight of these patients did not have teratoma ele-
viva1 for the 18 women with suboptimally debulked stage IIIC or stage IV disease (P = 0.98). The overall survival was not significantly different (P = 0.26). Neoadjuvant-treated patients tended to tolerate chemotherapy better as none required dose reduction for bone marrow suppression, while 6 of 18 conventionally treated patient required dose reductions. In conclusion, neoadjuvant chemotherapy appears to be an effective means of palliating women with clinical, radiological, and histologic findings compatible with advanced ovarian cancer. A prospective study is necessary in which women with findings compatible with advanced ovarian cancer that is not likely to be effectively cytoreduced surgically are randomized to either undergo cytoreductive surgery followed by chemotherapy or receive neoadjuvant chemotherapy.