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The role of second-look laparotomy in the management of patients with Stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide
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Citationsfrom the Literature
Changing trends in the surgical treatment of invasive carcinoma of the vulva Cavabagh D; Roberts WS; Bryson SCP; et al Department of Clinical Oncology, College of Medicine, Tampa, FL 33612, USA SURG. GYNECOL. OBSTET.; 162/2 (164-168) 1986 Twenty-nine years experience with 346 patients with invasive carcinoma of the vulva is presented. More than 90 per cent had squamous carcinoma. The primary mode of treatment was surgical. Two hundred and ninety-six patients were treated primarily with surgical treatment, 120 underwent radical vulvectomy and bilateral groin and pelvic lymphadenectomy, 133 had radical vulvectomy with bilateral groin dissection and 390 receiving nonradical procedures. Thirteen patients had radical operations plus pelvic exenteration for advanced disease. There were no intraoperative deaths, but 16 (5.4 percent) died within 28 days of the operation. The uncorrected over-all five year survival rate was 66 per cent. In the presence of negative nodes, it was 83 per cent and with positive nodes, it was 38 per cent. Fifty per cent of those treated with exenteration are alive and disease-free at five years or more. Since one-third of the patients presented with advanced disease (Stages III and IV), earlier diagnosis and prompt referral must be encouraged to improve surgical results. Sarcomas of the uterus: A cliiicopathologic study of 119 patients Kahanpaa KV; Wahlstrom T; Grohn P; et al Department of I and II of Obstetrics and Gynecology, Helsinki UniversityCentral Hospital, Helsinki, Finland OBSTET. GYNECOL.; 67/3 (417-424) 1986 This seriesconsistsof 119 uterine sarcoma patients treated at the University of Helsinki Central Hospital during the 20year period of 1958 to 1977. It comprises the three main histologic varieties: leiomyosarcomas, 51 patients; mixed mullerian sarcomas, 45 patients; and endometrial stromal sarcomas, 23 patients. The clinicopathological features that could have had a bearing on prognosis were examined retrospectively. The clinical stage at the time of primary treatment was the main prognostic factor. Other important factors were the degree of histologic differentiation and the mitotic activity. The overall five-year survival rate for patients with leiomyosarcomas was 39%; for mixed mullerian sarcomas, 33%; and for endometrial stromal sarcomas, 61%. The ten-year survival figures were 27, 14 and 37%, respectively. Some features of the diagnosis, the natural history, and the different methods of treatment of these diseases are discussed. Melphalan, S-fluorouracil, and medroxyprogesterone acetate in metastatic endometriai carcinoma Piver MS; Lele SB; Patsner B; Emrich LJ Department of Clinical Gynecologic Oncology, Roswell Park Memorial Institute, Buffalo, NY 14263, USA OBSTET. GYNECOL.; 67/2 (261-264) 1986 Fifty consecutive patients with recurrent and metastatic endometrial carcinoma were treated with melphalan, 5-fluorInt J Gynaecol Obstet 25
ouracil, and medroxyprogesterone acetate with or without tamoxlfen as first-line chemotherapy. The objective response rate was 48%, with 20% complete responses. The estimated median progression-free survival time was only five months (0.5 to 65 months) with estimated two- and five-year progression-free survival rates of 16 and 13%, respectively. The estimated median progression-free survival time was 24 months for complete responders; the progression-free survival times were significantly longer than the survival times (median = four months) for all other patients (P = 0.0002). Whether or not the addition of cytotoxic chemotherapy to progesterone hormonal therapy for metastatic endometrial carcinoma lengthens survival time is still open to question. The role of second-look laparotomy in the management of patients with Stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide Kirwan PH; Naftalin NJ; Khanna S; Aukett RJ Department of Obstetrics and Gynaecology, Leicester Royal Infirmary. Leicester LE2 7LX. UK BR. J. OBSTET. GYNAECOL.; 93/6 (629-633) 1986 Twenty-eight patients underwent a second-look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulklng procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumor had no effect on survival rates. Eighteen patients were surgically free of disease at the second-look procedure and of these, all are alive and disease free with a mean survival time of 39 months. Of the 10 patients with positive second-look procedures, four are dead. The mean survival for patients with positive second-look laparotomies was 30.7 months. Second-look laparotomy may contribute to increased survival if pelvic clearance was not attempted at initial staging laparotomy but should primarily be used to assess new agents and new combinations of chemotherapeutic agents and to define the optimum number of courses of chemotherapy.
The CA 125 assay as a predictor of clinical recurrence in epithelial ovarian cancer Niloff JM; Knapp RC; Lavin PT; et al Division of Gynecology and Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 0211.5, USA AM. J. OBSTET. GYNECOL.; 155/l (56-60) 1986 Serum CA 125 levels were obtained from 55 women with epithelial ovarian cancer before a second-look surgical procedure and serially thereafter. All patients were clinically and radiographically free of tumor at the time of the second-look operation and were followed to clinical recurrence. Median follow-up was 12 months. CA 125 levels obtained at the second-look operation had a sensitivity and spec!ficity for predicting clinical recurrence of 94% and 88%, respectively. Patients with an elevated CA 125 level (a35 U/ml) had a 60%
Citationsfrom the Literature
Changing trends in the surgical treatment of invasive carcinoma of the vulva Cavabagh D; Roberts WS; Bryson SCP; et al Department of Clinical Oncology, College of Medicine, Tampa, FL 33612, USA SURG. GYNECOL. OBSTET.; 162/2 (164-168) 1986 Twenty-nine years experience with 346 patients with invasive carcinoma of the vulva is presented. More than 90 per cent had squamous carcinoma. The primary mode of treatment was surgical. Two hundred and ninety-six patients were treated primarily with surgical treatment, 120 underwent radical vulvectomy and bilateral groin and pelvic lymphadenectomy, 133 had radical vulvectomy with bilateral groin dissection and 390 receiving nonradical procedures. Thirteen patients had radical operations plus pelvic exenteration for advanced disease. There were no intraoperative deaths, but 16 (5.4 percent) died within 28 days of the operation. The uncorrected over-all five year survival rate was 66 per cent. In the presence of negative nodes, it was 83 per cent and with positive nodes, it was 38 per cent. Fifty per cent of those treated with exenteration are alive and disease-free at five years or more. Since one-third of the patients presented with advanced disease (Stages III and IV), earlier diagnosis and prompt referral must be encouraged to improve surgical results. Sarcomas of the uterus: A cliiicopathologic study of 119 patients Kahanpaa KV; Wahlstrom T; Grohn P; et al Department of I and II of Obstetrics and Gynecology, Helsinki UniversityCentral Hospital, Helsinki, Finland OBSTET. GYNECOL.; 67/3 (417-424) 1986 This seriesconsistsof 119 uterine sarcoma patients treated at the University of Helsinki Central Hospital during the 20year period of 1958 to 1977. It comprises the three main histologic varieties: leiomyosarcomas, 51 patients; mixed mullerian sarcomas, 45 patients; and endometrial stromal sarcomas, 23 patients. The clinicopathological features that could have had a bearing on prognosis were examined retrospectively. The clinical stage at the time of primary treatment was the main prognostic factor. Other important factors were the degree of histologic differentiation and the mitotic activity. The overall five-year survival rate for patients with leiomyosarcomas was 39%; for mixed mullerian sarcomas, 33%; and for endometrial stromal sarcomas, 61%. The ten-year survival figures were 27, 14 and 37%, respectively. Some features of the diagnosis, the natural history, and the different methods of treatment of these diseases are discussed. Melphalan, S-fluorouracil, and medroxyprogesterone acetate in metastatic endometriai carcinoma Piver MS; Lele SB; Patsner B; Emrich LJ Department of Clinical Gynecologic Oncology, Roswell Park Memorial Institute, Buffalo, NY 14263, USA OBSTET. GYNECOL.; 67/2 (261-264) 1986 Fifty consecutive patients with recurrent and metastatic endometrial carcinoma were treated with melphalan, 5-fluorInt J Gynaecol Obstet 25
ouracil, and medroxyprogesterone acetate with or without tamoxlfen as first-line chemotherapy. The objective response rate was 48%, with 20% complete responses. The estimated median progression-free survival time was only five months (0.5 to 65 months) with estimated two- and five-year progression-free survival rates of 16 and 13%, respectively. The estimated median progression-free survival time was 24 months for complete responders; the progression-free survival times were significantly longer than the survival times (median = four months) for all other patients (P = 0.0002). Whether or not the addition of cytotoxic chemotherapy to progesterone hormonal therapy for metastatic endometrial carcinoma lengthens survival time is still open to question. The role of second-look laparotomy in the management of patients with Stage II, III and IV ovarian cancers following chemotherapy with cisplatin, adriamycin and cyclophosphamide Kirwan PH; Naftalin NJ; Khanna S; Aukett RJ Department of Obstetrics and Gynaecology, Leicester Royal Infirmary. Leicester LE2 7LX. UK BR. J. OBSTET. GYNAECOL.; 93/6 (629-633) 1986 Twenty-eight patients underwent a second-look laparotomy on completing triple agent chemotherapy with cisplatin, adriamycin and cyclophosphamide. The adequacy of the primary debulklng procedure and the stage of tumour were the most significant factors associated with a good prognosis. Grade and histological type of tumor had no effect on survival rates. Eighteen patients were surgically free of disease at the second-look procedure and of these, all are alive and disease free with a mean survival time of 39 months. Of the 10 patients with positive second-look procedures, four are dead. The mean survival for patients with positive second-look laparotomies was 30.7 months. Second-look laparotomy may contribute to increased survival if pelvic clearance was not attempted at initial staging laparotomy but should primarily be used to assess new agents and new combinations of chemotherapeutic agents and to define the optimum number of courses of chemotherapy.
The CA 125 assay as a predictor of clinical recurrence in epithelial ovarian cancer Niloff JM; Knapp RC; Lavin PT; et al Division of Gynecology and Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA 0211.5, USA AM. J. OBSTET. GYNECOL.; 155/l (56-60) 1986 Serum CA 125 levels were obtained from 55 women with epithelial ovarian cancer before a second-look surgical procedure and serially thereafter. All patients were clinically and radiographically free of tumor at the time of the second-look operation and were followed to clinical recurrence. Median follow-up was 12 months. CA 125 levels obtained at the second-look operation had a sensitivity and spec!ficity for predicting clinical recurrence of 94% and 88%, respectively. Patients with an elevated CA 125 level (a35 U/ml) had a 60%