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

Abstract

Background: Survival rates for patients with advanced epithelial ovarian cancer remain low despite improved chemotherapy regimens and cytoreductive surgery.

Methods: One hundred thirty-six patients with Stage III or IV ovarian cancer were treated with primary cytoreductive surgery followed by cisplatin induction, 1 mg/kg weekly x 4 followed by 10 cycles of cisplatin (50 mg/m2), doxorubicin (50 mg/m2), and cyclophosphamide (750 mg/m2). Second-look surgery was performed on those patients who were clinically without evidence of disease at the end of the planned chemotherapy course. Survival and progression-free survival were calculated, and prognostic factors regarding survival and progression-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 surgical complete response (SCR) rate of 34.9% and surgical partial response (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 survival 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 and progression-free survival.

Conclusion: Compared with those patients with greater than 1-cm residuum after initial surgery, a statistically significant improvement in long term survival was noted for those patients whose cancers were cytoreduced to less than 1-cm residuum.