LONG-TERM SURVIVAL BY CYTOREDUCTIVE SURGERY TO LESS-THAN 1-CM, INDUCTION WEEKLY CISPLATIN AND MONTHLY CISPLATIN, DOXORUBICIN, AND CYCLOPHOSPHAMIDE THERAPY IN ADVANCED OVARIAN ADENOCARCINOMA

Background. Survival rates for patients with advanced epithelial ovari an cancer remain low despite improved chemotherapy regimens and cytore ductive surgery.Methods. One hundred thirty-six patients with Stage II I or IV ovarian cancer were treated with primary cytoreductive surgery followed by cisplatin induction, 1 mg/kg weekly X 4 followed by 10 cy cles of cisplatin (50 mg/m(2)), doxorubicin (50 mg/m(2)), and cyclopho sphamide (750 mg/m(2)). Second-look surgery was performed on those pat ients who were clinically without evidence of disease at the end of th e planned chemotherapy course. Survival and progression-free survival were calculated, and prognostic factors regarding survival and progres sion-free survival were evaluated by both univariate and multivariate analyses. Results. Cytoreductive surgery to less than or equal to 2 cm was performed on 83% of patients and to less than 1 cm in 40%. A surg ical complete response (SCR) rate of 34.9% and surgical partial respon se (SPR) rate of 47.6% were noted. Of the SCRs, recurrences developed in 52.7% of the patients. Estimated 5- and 8-year survival for all 136 patients was 31.2% and 21.5%, and 5- and 8-year progression-free surv ival was 23.9% and 20.6%, respectively. Those patients with less than 1-cm residual disease after primary surgery had significantly improved survival compared with those with 1-2 cm or greater than 2 cm (P < 0. 001). Multivariate analysis identified residual disease status and age as the most significant prognostic factors associated with survival a nd progression-free survival. Conclusion. Compared with those patients with greater than 1-cm residuum after initial surgery, a statisticall y significant improvement in long term survival was noted for those pa tients whose cancers were cytoreduced to less than 1-cm residuum.