title: Long-term survival in ovarian cancer. Mature data from The Netherlands Joint Study Group for Ovarian Cancer.
abstract: In two studies initiated in 1979 and 1981, 377 patients were treated for advanced epithelial ovarian cancer. In the first study patients were randomly assigned to receive Hexa-CAF (hexamethylmelamine, cyclophosphamide, methotrexate, 5-fluorouracil) or CHAP-5 (cyclophosphamide, hexamethylmelamine, doxorubicin, cisplatin for 5 days) and in the second study to receive CHAP-5 or CP (cyclophosphamide, cisplatin on 1 day). Patients who did not respond to Hexa-CAF were offered subsequent treatment that included cisplatin. Median follow-up of patients in the first study was 9.5 years and in the second study 7.7 years. At 10 years 9% of the patients initially treated with Hexa-CAF and 21% of patients assigned to CHAP-5 were alive. Among the 10-year survivors treated with Hexa-CAF, 50% had experienced progressive disease but were alive as a result of retreatment with a cisplatin regimen. The survival curves of both studies revealed that approximately 60% of the patients who reached a complete remission were alive at 5 years and 40% at 10 years. Patients with microscopic disease at second-look had a less favourable outlook: 35% survived 5 years. Not recognised at first publication of both studies was the influence of tumour grade on survival. Before 5 years of follow-up, the good prognosis of grade 1 tumours (well differentiated) could not be detected. About 50% of patients with grade 1 tumours were alive at 5 and 30% at 10 years while these survival rates were halved for the other grades. Combination chemotherapy with cisplatin can enhance survival by more than 10% at 5 and 10 years compared with the best treatment of the precisplatin era: Hexa-CAF.
authors.affiliation: Department of Internal Medicine, Utrecht University Hospital, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Neijt
authors.forename: W W
authors.initials: WW
authors.lastname: ten Bokkel Huinink
authors.forename: M E
authors.initials: ME
authors.lastname: van der Burg
authors.forename: A T
authors.initials: AT
authors.lastname: van Oosterom
authors.forename: P H
authors.initials: PH
authors.lastname: Willemse
authors.forename: J B
authors.initials: JB
authors.lastname: Vermorken
authors.forename: A C
authors.initials: AC
authors.lastname: van Lindert
authors.forename: A P
authors.initials: AP
authors.lastname: Heintz
authors.forename: E
authors.initials: E
authors.lastname: Aartsen
authors.forename: M
authors.initials: M
authors.lastname: van Lent
mesh_terms: D006585:Altretamine / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D009367:Neoplasm Staging; D009426:Netherlands; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D013997:Time Factors
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D006585:Altretamine; D005472:Fluorouracil; D008727:Methotrexate