DOES AGGRESSIVE THERAPY IMPROVE SURVIVAL IN SUBOPTIMAL STAGE-IIIC-IV OVARIAN-CANCER - A CANADIAN-AMERICAN COMPARATIVE-STUDY

In an effort to determine if differences exist in the treatment and ou tcome of patients with suboptimally debulked stage IIIc and IV epithel ial ovarian cancer between two tertiary-care cancer centers in Canada and the United States, we conducted a comparative study, The records o f all patients who underwent treatment for epithelial ovarian cancer a t two tertiary-care cancer centers in Canada and the United States bet ween 1987 and 1989 were abstracted onto a common datasheet which was t hen entered into a computerized database for analysis. Only patients w ith suboptimally debulked stage IIIc disease (residual tumor diameter > 1 cm) or stage IV were included in the comparative study, There was a total of 129 evaluable patients (61 Canadian, 68 American). There we re no statistically significant differences between the centers in mea n age, performance status, histology, grade, or stage distribution, Du ring the period of this study there was no statistically significant d ifference between the two institutions in the proportion of patients i n whom optimal debulking was achieved (Canadian 19%, American 26%). Th e American patients were heavier than the Canadian patients (Quetelet index 27.3 vs 23.8, P < 0.006), Primary chemotherapy included a platin -containing regimen in 98 and 93% of Canadian and American patients, r espectively. The average number of laparotomies each patient received during her course of illness was 1.7 and 2.5 at the Canadian and the A merican centers, respectively (P < 0.0001). Similarly, the American pa tients received a higher mean number of different chemotherapy regimen s and total number of courses of chemotherapy during the course of the ir disease (3.0 and 12.6) than did the Canadian patients (2.4 and 8.8) (P < 0.01 and P < 0.001, respectively). The median survival was 21 mo nths and 20 months in the Canadian and the American patients, respecti vely (no significant difference), and the 5-year survival was 10% for the Canadian and 11% for the American patients, Despite significant di fferences in the overall aggressiveness of treatment between the two c enters, there was no difference in the survival of these patients. Unt il effective salvage agents or treatment strategies are realized, ''mo re is not necessarily better.'' (C) 1995 Academic Press, Inc