The feasibility of early administration of combination chemotherapy following cytoreductive surgery and second-look operation in patients with stage III ovarian carcinoma: a pilot study.

The purpose of this study is to evaluate the feasibility of early use of modified PAC-1 chemotherapy following debulking surgery and its efficacy by assessing disease status during a second-look operation. Twenty-six consecutive previously untreated patients with stage III ovarian carcinoma were evaluated in a prospective study over the 5-year period March 1981 to August 1986. Initial exploratory laparotomy was performed for staging and maximum cytoreduction. Within 24 hr postoperative modified PAC-1 (M-PAC-1) combination chemotherapy was administered and then repeated every 4 weeks for 11 months which was then followed by second-look operation. Patients were analyzed according to the following pretreatment characteristics: age, FIGO stage, histologic tumor type, extent of initial surgery, size of residual tumor, and findings during second-look. Nineteen patients were evaluable. No evidence of either microscopic or macroscopic disease was noted in 15 patients (79%), whereas the remaining 4 (21%) exhibited persistent disease. Of the remaining 7 patients not undergoing SLO, 4 completed 12 courses of chemotherapy but did not undergo surgery for medical reason (n = 2) or patient refusal (n = 2). Two more patients refused chemotherapy after 9 courses and the seventh patient expired with persistent disease after 8 courses. The early use of combination chemotherapy was well tolerated. Neurological, hematological, and renal toxicity was never severe enough to cause discontinuation of therapy.

Lipid associated sialic acid in plasma in patients with advanced carcinoma of the ovaries.

Plasma lipid associated sialic acid (LASA-P) was evaluated in relation to disease status and disease progression in a total of 52 consecutive patients with advanced carcinoma of the ovaries (FIGO stage III and IV). Forty-three individuals with benign gynecologic diseases served as controls. There were three groups. Group 1 included 23 untreated patients who had LASA-P values above normal before debulking operations. Group 2 consisted of 12 patients who completed 12 courses of chemotherapy after debulking operations and presented with negative findings at second look operation (SLO). LASA-P levels were measured in these patients prior to SLO. Eight of 12 patients had normal LASA-P values for a specificity rate of 67 per cent. Four patients had elevated values with no clinical evidence of disease. Group 3 had 17 patients who failed to respond to cytotoxic chemotherapy after initial debulking procedures. All patients in this group had persistent or recurrent disease that was documented at re-exploration or at SLO. Elevated LASA-P levels were noted in 14 of 17 patients for a sensitivity rate of 82 per cent. Rising LASA-P values in serial samples were the only signs of disease recurrence in three of five patients who completed 12 courses of chemotherapy and in whom SLO showed surgical evidence of disease. The predictive value for positive and negative results for all patients were 92.2 and 72.7 per cent, respectively. In spite of the relatively low sensitivity and specificity rates in groups 2 and 3, LASA-P can be used successfully as a valuable adjunct to monitor the course of the disease during treatment in patients with advanced carcinoma of the ovaries.