Sequential multimodality therapy of bulky and/or inoperable ovarian cancer

ABSTRACT

From January, 1986, through December, 1991, Sixty five consecutive patients with diagnosis of Ovarian cancer were referred to Radiotherapy and Nuclear Medicine Department Ain Shams University Hospitals [ASUH] and Gynaecology and Obstetrics Department, Zagazig University Hospitals, and General Surgery Department Ain Shams University Hospitals. The mean age was 44.92 +/- 14.44 years, [range 15-65 years], stage distribution was as follows stage I. 8 patients; stage II, 21 patients; stage III. 23 patients and stage IV, 13 patients. The histologic diagnosis was epithelial cell tumors in 47 patients [37. mucinous adenocarcinoid and 10. serous cystadenocarcinoma; germ cell tumors in 13 patients [8. dysgerminoma. 5 mixed germ cell tumor]; and 5 stromal cell tumors [3 granulosa cell - tumor and 2 theca cell tumor]. All the 65 patients were initially managed by surgical procedure, then given three to six cycles of systemic cisplatinum based chemotherapy according to the histology of their ovarian tumor, 47 patients with epithelial ovarian malignancies received cisplatin and S-fluorouracil [PF], 13 patients with germ cell tumors received cisplatin, vinblastine and bleomycin [PVB] and 5 patients with stromal ovarian tumors received cyclophosphamide, adriamycin and cisplatinum [PAC] combination. Twenty eight patients with either inadequate primary surgery [10] or with partial response to chemotherapy [18], underwent second look operation, where re-evaluation and secondary cytoreductive surgery was carried out for each case. Fifty one of the sixty five patients included in this series received irradiation either as WAR 3000 c Gy/6 weeks with boosting the dose to pelvis by 2000 c Gy /2 weeks done in 26 patients] or as Martinez technique in 25 patients]. Three patients, in addition to their primary radiotherapy; received palliative irradiation during their course of follow up for bone metastases. Mean follow up in months was 26.1 +/- 11.6, [range 9-54 months]. Forty seven patients [72.3%] were alive with no evidence of disease [NED] after mean free survival in months of 28.4 +/- 11.5. Seventeen patients [26.2%] lived with disease [LWD] ranging from 9-28 months with mean follow up of 15.14. Only one death [1.5%] due to disease was recorded. Two patients have lost follow up, 9-12 months after completion of their treatment and they had NED. Tolerance to multimodality treatment was very good in this series, no cases experienced grade III or IV toxicity of WHO classification, although 30.4% experienced nausea, vomiting and/or diarrhea during the WAR. One patient developed intestinal obstruction as a sequela of RTH, 9 months after completion of WAR. Martinez technique showed superiority in the patients' tolerance. Also tolerance to various chemotherapeutic regimen was acceptable