HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STE M-CELL SUPPORT FOR THE TREATMENT OF GYNECOLOGIC TUMORS IN ADULTS

Autologous bone marrow transplantation for the treatment of gynecologi c tumors in adults remains an uncommon therapeutic approach, The feasi bility of such high-dose therapies is clearly proved, especially with the advent of hematopoietic growth factors and the rescue by the perip heral stem cells to reduce the duration of the chemotherapy-induced my eloid aplasia. The question is to exactly define the place of high-dos e therapy in the land of solid tumors, In tile treatment of poor progn osis breast cancer, high-dose therapy with autologous bone marrow tran splantation or with peripheral stem cells support is able to converte some patients with partial response into complete responders. However, the consequences on overall survival and disease-free survival are no t convaincing, For metastatic breast cancer and for poor-prognosis tum ors (inflammatory breast cancer, axillary metastatic nodes greater tha n or equal to 8), the interest of high-dose therapy has to be determin ed by randomized studies. These studies are ongoing in USA and in Fran ce. For the treatment of poor-prognosis ovarian cancer, the situation is more difficult to appraise, Randomized studies have to be done to p recisely define the interest of high-dose therapy in terms of response and disease-free survival for the treatment of ovarian carcinomas.