TREATMENT OF OVARIAN-CANCER WITH SURGERY, SHORT-COURSE CHEMOTHERAPY AND WHOLE ABDOMINAL RADIATION

Background: The primary aim was to induce a high number of pCR in earl y (FIGO IC, IIB + C) - and advanced (FIGO III-IV)- stage ovarian cance r with a surgery plus 4 cycles of cisplatin and melphalan (PAMP) regim en. The second objective was to prevent relapse with WAR in patients i n remission after chemotherapy. Patients and methods: 218 eligible pat ients were treated after staging laparotomy with cisplatin 80 mg/sqm i .v. on day 1 and melphalan 12 mg/sqm i.v. on day 2 q 4 weeks. Response was verified by second-look laparotomy. WAR was carried out with the open field technique on a linear accelerator (daily dose: 1.3 Gy, tota l dose: 29.9 Gy) in patients with pathological or clinical CR or patho logical PR with microscopical residual disease. Results: 146/218 patie nts (67%, 95% CI: 61%-73%) responded to PAMP: 56 (26%) achieved pCR, 2 4 (11%), cCR, 56 (26%) pPR and 10 (5%) cPR (c = clinical, p = patholog ical). Multivariate analyses revealed that in advanced stages (92 case s in remission), the achievement of PCR was the most important factor for longer time to failure (TTF) and survival. Only 51/118 (43%) patie nts in remission received WAR. Early-stage patients <= 55 years were m ore likely to have WAR than patients older than 55 years (77% vs. 23%; p = 0.02). Advanced-stage patients with cCR were less likely to be ir radiated than patients with pCR or pPR (10% vs. 51%; p = 0.003). Toxic ity of PAMP was acceptable with 10% of WHO grade 4 hematologic toxicit y. Acute hematological toxicity of WAR caused interruption (33%) or in completeness (33%) of irradiation in the majority of patients. Conclus ions: PAMP is an effective treatment for advanced ovarian cancer with a 67% response rate after 3 cycles. For the majority of patients in re mission, WAR as a consolidation treatment was hardly feasible. For the se patients new treatment modalities to consolidate remission are need ed.