LONG-TERM SURVIVAL IN ADVANCED OVARIAN-CANCER AFTER CYTOREDUCTION ANDCHEMOTHERAPY TREATMENT

Ninety-one patients with untreated epithelial ovarian cancer, stages I II and IV, were treated according to a therapeutic protocol including cytoreductive surgery whenever possible, chemotherapy with CAP (cyclop hosphamide, doxorubicin, and cisplatin) and second-look laparotomy for those patients achieving a clinical remission. Optimal cytoreductive surgery (residual tumor < 2 cm) was not performed in 66 patients (72.5 %). A negative second-look laparotomy demonstrated a pathological comp lete remission in 26 patients (28.5%). After a median follow-up of 80 months, the disease-free survival is 19.7% (18 of 91 patients). Median survival was greater in optimal cytoreductive surgery patients (47 mo nths) than in the rest of the patients (22 months) (P = 0.0000). Survi val was also better in pathological complete remission patients (46 mo nths) than in partial remission PR) or no response patients (22 months ) (P = 0.0001). (Optimal secondary cytoreductive surgery was possible in 11 patients in PR after chemotherapy. Survival in this group was si milar to that of pathological complete remission cases. Currently, 53% of patients with initial residual tumor < 2 cm and complete response at second-look remain free of disease. In a multivariate analysis, res idual tumor > 2 cm and stage IV disease were the most significant prog nostic factors. The same analysis indicates that response to chemother apy at second laparotomy is not an independent prognostic factor. In c onclusion, our study indicates that the two most important prognostic factors in advanced ovarian carcinoma are the extent of the initial su rgery and stage. (C) 1994 Academic Press, Inc.