MALIGNANT MIXED MESODERMAL OVARIAN TUMOR TREATMENT AND PROGNOSIS - A 20-YEAR EXPERIENCE

Mixed mesodermal sarcoma of the ovary is a rare clinical entity. To re view the epidemiology, prognostic factors, and treatment results relat ed to primary ovarian sarcoma at our center, a retrospective chart rev iew of all patients referred for ovarian cancer was carried out from 1 974 to 1994. Cases with confirmed pathologic diagnosis of primary mixe d mesodermal ovarian sarcomas were selected, forming the present study group. Thirty-six charts were identified. The median age at presentat ion was 67.5 years. Findings at laparotomy demonstrated extraovarian m etastasis in 33/35 patients. Total abdominal hysterectomy and bilatera l salpingo-oophorectomy +/- omentectomy were performed in 34 patients, with 22 patients left with macroscopic residual disease after surgery . Follow-up adjuvant chemotherapy consisting of cisplatin and doxorubi cin was administered to 29/36 patients. Follow-ups ranged from 1 to 11 years with a median of 2 years. As with epithelial ovarian cancer, re sidual disease after initial surgery is an important prognostic factor . Thirteen patients had a second-look laparotomy. Five patients were p ositive for disease. Eight patients, one of whom recurred, were histol ogically negative. The patients with positive second-look findings, as well as all those who recurred clinically, subsequently died within 1 2 months despite trials with different second-line chemotherapeutic ag ents. Survival analysis showed a median survival of 3 years among pati ents treated with combination cytotoxic chemotherapy. Primary ovarian sarcomas make up about 2-3% of all ovarian cancer cases seen in our ce nter. These are often very aggressive tumors with widespread metastasi s at the time of presentation, making optimal tumor debulking difficul t. The combination of cisplatin and doxorubicin appears to have activi ty resulting in a survival of 35% at 5 years. Second-look surgery offe rs little helpful information on the management of these tumors. (C) 1 997 Academic Press.