title: Response to neo-adjuvant intraperitoneal and intravenous immunochemotherapy followed by interval secondary cytoreduction in stage IIIc ovarian cancer.
abstract: METHODS
  The aim of this study was to determine the effect of intraperitoneal (i.p.) neo-adjuvant immunochemotherapy, followed by secondary interval cytoreduction in bulky ovarian carcinoma, considered inoperable at first exploratory laparotomy.
  
  
  METHODS
  From 1980 to 1996, 13 naive patients with stage IIIc ovarian cancer underwent an initial laparotomy. Cytoreduction was judged too dangerous in these patients due to the large bulk of the tumor and the extent of peritoneal carcinomatosis. Simple biopsies were performed. The patients received an intraperitoneal cisplatin-based protocol monthly plus immunotherapy (DGZ). The interval secondary cytoreduction was started either when the patients seemed to be in complete remission or after a minimum of 4 courses of chemotherapy if the patients' results were stagnant or deteriorated. Immunochemotherapy was then resumed for a total of up to 10 courses.
  
  
  RESULTS
  At secondary cytoreduction, six patients were in complete remission as demonstrated histologically and cytologically. Seven patients were in incomplete remission. In six, debulking was completed without visceral resection. The seventh patient still had nodules more than 2 cm in diameter. Median overall survival was 57 months (range: 6-165).
  
  
  CONCLUSIONS
  Intraperitoneal immunochemotherapy was effective in bulky tumors, making optimal secondary cytoreduction possible in almost all cases.
authors.affiliation: Bichat Hospital, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Zylberberg
authors.forename: D
authors.initials: D
authors.lastname: Dormont
authors.forename: S
authors.initials: S
authors.lastname: Janklewicz
authors.forename: E
authors.initials: E
authors.lastname: Darai
authors.forename: J J
authors.initials: JJ
authors.lastname: Bretel
authors.forename: C
authors.initials: C
authors.lastname: Poncelet
authors.forename: J L
authors.initials: JL
authors.lastname: Guillet
authors.forename: P
authors.initials: P
authors.lastname: Madelenat
mesh_terms: D000328:Adult; D000368:Aged; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000628:therapy*; D018284:Cystadenocarcinoma, Serous / Q000145:classification / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007274:Injections, Intraperitoneal; D007275:Injections, Intravenous; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000145:classification / Q000473:pathology / Q000628:therapy*; D012086:Reoperation; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome