High-dose melphalan and autologous bone marrow support for treatment of ovarian carcinoma with positive second-look operation.
Patients with epithelial ovarian carcinoma (OVCA) and positive second-look operation (SLO) have a poor short-term prognosis. Treatment after SLO is still controversial and pilot studies are justified in an attempt to improve survival of these patients. As OVCA is known to be a chemosensitive tumor, it seems logical to treat these patients with high-dose chemotherapy with the support of an autologous bone marrow transplantation. Fourteen patients underwent primary surgery with tumor debulking followed by cis-platinum-based chemotherapy. SLO was performed in each patient and was microscopically positive in five and macroscopically positive with secondary debulking in nine. All patients were treated after SLO with high-dose melphalan (HDM), 140 mg/m2, and autologous bone marrow support. HDM was well tolerated, with a median time to granulocyte recovery of 21 days. There was no death due to treatment toxicity. The mean follow-up after SLO is 43 months. Five patients (35.7%) are disease free at 30 to 60 months after SLO with no further treatment and, thus, a good quality of life. Four patients are alive with recurrent disease. Five patients died of OVCA; actuarial 3-year survival is 64%. This therapeutic procedure is well tolerated and seems to provide long-term survival for patients with no complete response after first-line chemotherapy. Therefore, it might also be applied to patients at high risk of recurrence after a negative SLO.
Dauplat
J
J
Centre Jean Perrin, Clermont-Ferrand, France.
Legros
M
M
Condat
P
P
Ferriere
J P
JP
Ben Ahmed
S
S
Plagne
R
R
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D000328:Adult; D016026:Bone Marrow Transplantation; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006410:Hematopoiesis / Q000187:drug effects; D006801:Humans; D008558:Melphalan / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D010865:Pilot Projects; D012086:Reoperation
D008558:Melphalan