The impact of cisplat based chemotherapy on advanced ovarian cancer.

Cisplatinum based chemotherapy has become the standard treatment for ovarian cancers due to its proved superiority over non-cisplat based regimes. However, the therapeutic impact of cisplat based regimes compared to cheaper non-cisplatinum based regimes is questionable when multiple variables such as residual disease, histologic type, grade are introduced. This report is a study of 110 Stage III ovarian cancer patients from 1985-89, with cisplat (n = 69) and non cisplat (n = 41) based chemotherapy. The results of both regimes with reference to the multiple variable factors are presented. We conclude that cisplat based regimes appear to be superior to non-cisplat based regimes except probably in poorly differentiated ovarian tumors where the results were similar with either regimen.

Superficial bladder cancer. A 10 year experience.

A total of 236 patients - 198 males and 38 females with superficial bladder cancer (stage A(TaT1)) were treated with transurethral resection of the tumours. Intravesical chemotherapy (84 patients) or immunotherapy (27 patients) was added in those patients considered to be at high risk of developing local recurrences or stage progression. The five and ten years survival in the single tumour group (117 patients) were 86 percent and 72.9 percent as compared to 72.5 percent and 70.7 percent respectively in the multiple tumour group (119 patients). The five and ten year survival rates for grade I tumours were 88.3 percent and 86 percent respectively, for grade II tumours 80.8 percent and 64 percent and for grade III tumours 56.9 percent and 46 percent respectively. The impact of tumour grade on survival was found to be independent of the number of tumours. The response rates to intravesical thiotepa was 54.9 percent mitomycin 60 percent and with BCG 71.5 percent. All the three reduced the local recurrence rates and increase the mean interval to recurrence but the stage progression rate was significantly lowered only with intravesical BCG. In our study, we have used the Danish strain of BCG available to us and have found it to yield response rates comparable to other centres using Tice or Pasteur strains.

Do we need to do comprehensive surgical staging in all cases of clinical early ovarian cancer?

Meticulous staging of ovarian cancer has so far been a prerequisite for treatment planning. However, more than 80% of patients operated by non-oncologists all over the world do not under go a complete staging. Recently there have been reports questioning the need for extensive staging from the point of cervical benefit. We have analysed our data of 64 stage ovarian cancer patients to see if clinical staging was adequate or relaparotomy with restaging is necessary. We conclude that though pathological staging is important for proper reporting of results and evaluation of treatment modalities, in the existing circumstances, a judicious use of clinical methods and taking available pathological factors into account, we can still produce comparable results with restricted use of relaparotomy.

Morbidity & mortality following craniofacial resections.

A seven year experience with twenty patients undergoing the craniofacial approach for excision of tumours of the paranasal sinus and orbit is presented. Results indicate a low postoperative morbidity and mortality with excellent cosmesis. Good palliation is achieved in the presence of extensive disease, while large tumours which would have been considered inaccessible can be resected. Its advantage recommend it as the treatment of choice for tumours of the orbit and paranasal sinuses.