Advanced Ovarian Cancer: Brief Intensive Combination Chemotherapy and Second-Look Operation

The effects of brief intensive combination chemotherapy have been evaluated in 59 patients with advanced epithelial ovarian cancer. Following surgery and before chemotherapy, 16 patients had limited residual cancer (tumor nodules 3 cm or less in diameter) and 43 had bulky disease (tumor nodules greater than 3 cm). Chemotherapy with hexamethylmelamine, cyclophosphamide or 5-fluorouracil, doxorubicin, and cisplatin was given intensively. Myelosuppression was the most serious side effect, although gastrointestinal, neurologic, and renal toxicity was also observed. Fifty-five of the 58 (95%) evaluable patients had either a partial clinical response or no clinically detectable tumor following therapy. Forty-five of these 55 patients underwent a second-look surgical evaluation at 6 months; 17 of 45 patients (14 of 16 patients with limited residual disease and 3 of 29 with bulky disease) had no evidence of residual cancer, and 9 patients had all known cancer resected. Sixteen of 17 patients who attained a complete response as judged by laparotomy remain in remission; median follow-up has been 19 months (range, 9 to 30 months) following chemotherapy. This combination chemotherapy produces marked tumor regression as judged by second-look surgical evaluation, and most patients who had limited residual disease have all evidence of cancer eradicated. Longer observation is required to determine how many of these patients will remain continuously free of ovarian cancer.