The reassessment of patients with ovarian carcinoma

Adjuvant Treatment with Melphalan in Ovarian Carcinoma with no Residual Disease following Surgery

Forty-nine patients classified after surgery and complete non-surgical restaging as « no residual disease » were treated with adjuvant chemotherapy. Thirty-nine patients had ovarian carcinoma and 10 borderline tumors. All patients had geographic inaccessibility. Domiciliary treatment with melphalan at the dose of 10 mg/day p.o. for 5 consecutive days every 4 weeks for 12 cycles was used. Within 6 months from the end of adjuvant treatment a second restaging with peritoneoscopy and peritoneal cytology was performed. The median administered dose of melphalan was 575 mg. No patient with a borderline tumor relapsed. Nine patients with ovarian carcinoma relapsed (23 %): 4/10 at stage II-III and 5/29 (17 %) at stage I. The relapse-free survival at 96 months was 77 % for stage I patients and 73 % for all patients. The overall survival was 87 % for stage I patients and 81 % for all patients. Mild myelodepression was evident in 65 % of patients. No case of acute nonlymphocytic leukemia was observed.

Staging and treatment of ovarian carcinoma

The staging and treatment of ovarian cancer is reviewed with special attention to developments during the last decade. Pathways of spread, presurgical and surgical staging are described and discussed, as are the biologic characters of the different histologic subtypes. Principles of surgery, endoperitoneal and external radiotherapy, single-drug and multiple-drug systemic chemotherapy (therapeutic and adjuvant), intraperitoneal chemotherapy, second-line chemotherapy, hormone therapy and the use of biologic response modifiers are reported and discussed with background of recent clinical trials. It is concluded that considerable progress has been made concerning diagnosis, staging and treatment of ovarian cancer. The proportion of cases in advanced stages has thus decreased and the survival rate increased. However, it is also obvious that the long-term prognosis for patients with advanced disease has not significantly improved over the last 10 years, despite introduction of multiple-drug regimens with high initial response rates. Ovarian cancer remains the most important gynecologic cause of death in the Western countries.

Laparoscopy in staging, follow-up, and restaging of ovarian carcinoma

Laparoscopy was systematically employed for the study of 143 cases of primary ovarian tumor in the various phases of staging, treatment, follow-up, and restaging. We found that laparoscopy allowed a more precise staging if used before laparotomy. Verification of response at any time in the course of therapy was readily achieved by laparoscopy.

Ovarian cancer in the elderly: an analysis of Surveillance, Epidemiology, and End Results Program data

With use of a unique data set from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute for 11,062 women diagnosed with ovarian cancer from 1973 to 1982, this study focuses on the impact of old age on this malignancy. Aspects of ovarian cancer as it pertains especially to elderly women (those 65 years or older) are examined according to age/stage relationships at initial diagnosis and age variations in treatment and survival. Elderly women are more likely than younger women to be in advanced stages of ovarian cancer at initial diagnosis, and they constitute about 42% of this group. In the stage-unknown category, over 50% are 65 years or older. Data suggest that elderly women are treated more conservatively than younger patients. The National Cancer Institute data also illustrate the increased preference to treat this neoplasm with surgical procedures and chemotherapy rather than surgical procedures and radiation. For Stages III and IV disease, 5-year relative survival rates for elderly women are almost one half of the rate observed for women under 65. Although the prognosis of patients with advanced ovarian tumors is poor for all, it is even worse as age progresses.