title: Tumor debulking followed by immediate combination chemotherapy in advanced ovarian carcinoma. Phase II.
abstract: Fifty-one consecutive, previously untreated patients with FIGO stage III or IV epithelial ovarian carcinoma were enrolled in a prospective study over a period of 7 years (1981-1988). Significant improvement has been noted in patients with advanced ovarian cancer following the administration of modified PAC 1 (adriamycin, cytoxan and cyclophosphamide) immediately following primary debulking surgery (within 24 hours) and repeated for 11 monthly cycles. A second look operation was found as an important prognostic indicator. Thirty-one patients (all Stage III) completed the chemotherapy course and were eligible for second look operation. Of these, 21 patients (68%) showed negative second look. Of the patients with negative second look, 17 of 21 (81%) are alive with a mean survival of 61 months (range 19-103 months) after diagnosis. Among those with positive second look only 3 of 10 are alive with a mean of 41 months after diagnosis. The remaining 20 patients (13 stage III and 7 stage IV) did not undergo second look laparotomy. Only 2 of these 20 patients are alive with a mean of 35 months after diagnosis. Other factors of significant importance were: age and completion of chemotherapy course. Patients appeared to benefit from the combined regimen of optimal debulking surgery, completion of 12 courses of chemotherapy with the first course administered immediately after surgery and second look operation. Tumor type or histologic grade did not seem to influence results. The early use of chemotherapy was well tolerated and toxicity was minimal and acceptable.
authors.affiliation: Department of Obstetrics and Gynecology, Maimonides Medical Center, State University of New York, Brooklyn.
authors.forename: J R
authors.initials: JR
authors.lastname: Vardi
authors.forename: G H
authors.initials: GH
authors.lastname: Tadros
authors.forename: D
authors.initials: D
authors.lastname: Zamurovic
authors.forename: S D
authors.initials: SD
authors.lastname: Rafla
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008137:Longitudinal Studies; D008875:Middle Aged; D019158:N-Acetylneuraminic Acid; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000628:therapy*; D011446:Prospective Studies; D012086:Reoperation; D012794:Sialic Acids / Q000097:blood; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; D014408:Biomarkers, Tumor; D008055:Lipids; D012794:Sialic Acids; C054080:lipid-associated sialic acid; D004317:Doxorubicin; D003520:Cyclophosphamide; D019158:N-Acetylneuraminic Acid; D002945:Cisplatin