New methods applied to the analysis and treatment of ovarian cancer

The development of rigorous staging methods, appreciation of new knowledge concerning ovarian cancer dissemination, and administration of new treatment techniques have been applied to ovarian cancer. The method of staging consists of peritoneal cytology, total abdominal hysterectomy-bilateral salpingo oophorectomy (TAH-BSO), omentectomy, nodal biopsy, diaphragmatic inspection and is coupled with maximal surgical resection. An additional examination being evaluated for usefulness in future staging is intraperitoneal 99Tc sulfur colloid scans. Nineteen patients have entered the pilot studies. Sixteen patients (5 Stage 2, 10 Stage 3 micrometastatic, and 1 Stage 4) have been treated with colloidal 32P, i.p. followed 2 weeks later by split abdominal irradiation (200 rad fractions pelvis-2 hr rest-150 rad upper abdomen) to a total abdominal dose of 3000 rad with a pelvic cone down to 4000 rad. Five of these patients received Phenylalanine mustard ( l-PAM) (7 mg/m 2) maintenance therapy. The 3 year actuarial survival was 78% and the 3 year disease free actuarial survival 68%. Seven patients were treated with intraperitoneal tumor antisera and 4 7 remain in complete remission as of this writing. The specificity of the antiserum has been demonstrated by immunoelectrophoresis in 4 4 patients, and by live cell fluorescence in 1 patient. Rabbit IgG levels revealed significant increasing titers in 4 6 patients following i.p. antiovarian antiserum. Radiolabeled IgG derived from the antiserum demonstrated tumor localization and correlation with conventional radiography and computerized axial tomography (CAT) scans in 2 patients studied to date. Biomarker analysis reveals that free secretory protein 6 6 , alpha globulin 5 6 , and CEA(carcinoembryonic antigen) 3 6 were elevated in the 6 patients studied. Two patients whose disease progressed demonstrated elevated levels of all three biomarkers. There has been no significant acute toxicity nor morbidity with the use of antiserum nor with the integration of colloidal isotopic therapy and external irradiation.