Skin Metastasis of Ovarian Cancer: Report of Three Cases

Three cases of skin metastases in patients with ovarian cancer are reported. The late onset of skin metastases in the course of the disease represents an advanced stage accompanied by Intraperitoneal spread and has a poor prognosis. Diagnosis and differentiation from herpes zoster and other skin tumors were based on histologic examination. Palliation of symptoms and partial local response were achieved by electron beam irradiation.

OK-432 injection therapy for cystadenocarcinoma of the parotid gland: A case report

OK-432 is an immunomodulator that has been reported to be efficacious as an injection therapy for cervical lymphomas and ranulas. We performed OK-432 injection therapy to treat a cystadenocarcinoma of the parotid gland in a 72-year-old man. The 50 × 46-mm tumor was located in the deep lobe of the gland. The tumor had compressed the glossopharyngeal, vagus, and hypoglossal nerves, causing neurally mediated syncope, hoarseness, dysphagia, and dysarthria. A concentration of 5 KE/2 ml of OK-432 was injected. Within 2 months, the cyst had disappeared; no recurrence was apparent during 59 months of follow-up. To the best of our knowledge, no previous report has described injection of OK-432 for malignant cystic disease. We describe the injection method, injection dose, and postinjection course in the hope that this information will prove useful for future applications against malignant cystic disease.

[Expression of COP9, JAK2, HSP and NADH in ovarian carcinoma tissues after taxol-chemotherapy and their significance]

OBJECTIVE

To study the expression of COP9, JAK2, HSP and NADH genes in ovarian carcinoma tissues after taxol-chemotherapy and their significance.

METHODS

The up-regulated genes of JAK2, HSP, NADH and the down-regulated gene of COP9, which were revealed by micro-array from our previous study were examined by RT-PCR and real-time-PCR in 33 cases of ovarian cancer who previously received taxol-based chemotherapy (group 1), and 21 cases of ovarian cancer who never received chemotherapy before operation (group 2).

RESULTS

The expression rate of COP9 gene in group 1 was detected markedly lower than that in group 2 (39% vs 95%, P < 0.01); whereas the expression rates of JAK2, HSP and NADH in group 1 were significantly higher that those in group 2 (91%, 97%, 94% vs 29%, 48%, 43%; all P < 0.05). And the expression of COP9, HSP and NADH genes had no significant differences among histological grades. However, a significantly higher expression of JAK2 gene was seen in grade 3 than in grade 1-2 (P < 0.01). No significant difference in the expression rates of the 4 genes was seen among various tumor types or chemotherapy courses (P > 0.05). Real-time PCR showed that the level of COP9 gene copies of group 1 was significantly lower than that of group 2 (568, 1866 respectively; P < 0.05). However, HSP, JAK2 and NADH genes had significantly higher copy numbers in group 1 than in group 2 (5766, 7653, 3200 in group 1 and 3341, 3094, 1522 in group 2, respectively; all P < 0.05). In the subgroup that received 6-10 chemotherapy courses, the copy concentrations of JAK2, HSP, NADH genes were higher than those in the subgroup that received 2-4 chemotherapy courses (all P < 0.05). In addition, we found a higher copy concentrations of JAK2, HSP, NADH genes in grade 3 than in grade 1-2 (all P < 0.05). Though no significant differences in gene copy concentrations of the 4 genes were seen among variable tumor types. In stage IV, the copy concentrations of HSP and NADH genes were higher than those in stage III (P < 0.01, P < 0.05 respectively), but the copy concentrations of COP9, JAK2 genes had no significant differences (both P > 0.05). There were positive correlations among JAK2, HSP and NADH genes (r = 0.56, 0.44, 0.57 respectively, all P < 0.01). COP9 gene was found to have a negative correlation with JAK2 gene (r = -0.48; P < 0.01), but not with HSP and NADH genes (r = -0.18, -0.06, respectively; both P > 0.05).

CONCLUSION

The down-regulation of COP9 gene and up-regulation of JAK2, HSP, and NADH genes are related to the mechanism of drug-resistance in ovarian cancer.

Chemotherapy versus surgery for initial treatment in advanced ovarian epithelial cancer

BACKGROUND

Epithelial ovarian cancer presents at an advanced stage in the majority of patients. These women require chemotherapy and surgery for optimal treatment. Conventional treatment is to perform surgery first and then give chemotherapy. However, it is important to determine whether there is any advantage to using chemotherapy prior to surgery.

OBJECTIVES

To assess whether there is an advantage to treating women with advanced epithelial ovarian cancer with chemotherapy prior to debulking surgery (neoadjuvant chemotherapy) compared with conventional treatment where chemotherapy follows maximal debulking surgery.

SEARCH STRATEGY

RCTs were identified by searching The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2006), MEDLINE (Silver Platter, from 1966 to 1st Sept 2006), EMBASE via Ovid (from 1980 to 1st Sept 2006), CANCERLIT (from 1966 to 1st Sept 2006), PDQ (search for open and closed trials) and MetaRegister (most current search Sept 2006).

SELECTION CRITERIA

Women with advanced epithelial ovarian cancer (Federation of International Gynaecologists and Obstetricians (FIGO) stage III-IV); randomized allocation to treatment groups which compared platinum-based chemotherapy before debulking surgery with platinum-based chemotherapy following debulking surgery.

DATA COLLECTION AND ANALYSIS

Data were extracted by three independent authors, and the quality of included trials was assessed by three independent authors.

MAIN RESULTS

One RCT was identified as meeting the inclusion criteria. This trial randomized 85 women and compared standard debulking surgery followed by eight cycles of platinum-based chemotherapy with pre-operative intra-arterial platinum-based chemotherapy and ovarian artery embolization followed by debulking surgery and seven cycles of platinum-based chemotherapy. There was no statistical difference in median overall survival (OS) between the two treatment groups. Three on-going RCTs were identified and their results are awaited.

AUTHORS' CONCLUSIONS

There is as yet no good evidence that neoadjuvant chemotherapy prior to debulking surgery for women with advanced epithelial ovarian cancer is superior to conventional debulking surgery and platinum-based chemotherapy.

[A case of recurrent biliary cystadenocarcinoma successfully treated with 5FU/CDDP systemic chemotherapy]

We report a case of biliary cystadenocarcinoma which recurred 41 months postoperatively. A 60-year-old woman was admitted for further examination of multiple metastatic tumors and a large amount of ascites. Systemic administration of 5FU and CDDP caused her CEA level to decrease gradually and abdominal computed tomography revealed considerable reduction of the metastatic tumors and ascites. Since her general condition had improved, chemotherapy was continued in the outpatient clinic.

Initial chemotherapy followed by surgical cytoreduction for the treatment of stage III/IV epithelial ovarian cancer

OBJECTIVE

The purpose of this study was to evaluate differences in morbidity, progression-free interval, and survival in women with advanced epithelial ovarian cancer treated with initial chemotherapy versus initial surgery.

STUDY DESIGN

All women with epithelial ovarian cancer who were treated surgically at our hospital between January 1, 1995, and January 1, 2003, were eligible; the cases of 200 patients met the criteria and underwent retrospective chart review.

RESULTS

Ninety-eight patients (49%) had initial chemotherapy, and 102 patients (51%) had initial surgery. Patients who received initial chemotherapy were more likely to have stage IV disease (initial chemotherapy, 27%, vs initial surgery, 8%; P = .042) and grade 3 disease (initial chemotherapy, 73%, vs initial surgery, 61%; P = .025). Optimal cytoreduction was achieved more often in patients who received initial chemotherapy (initial chemotherapy, 86%, vs initial surgery, 54%; P < .001). Only optimal cytoreduction (P = .022), and not treatment choice (P = .089), had an impact on median survival.

CONCLUSION

Initial chemotherapy is a reasonable alternative to initial surgery for the treatment of selected patients with advanced epithelial ovarian cancer.

[Prognostic factors and better survival rate after the treatment of advanced ovarian cancer with neoadjuvant chemotherapy]

The better survival rate was evaluated as well as the prognostic factors due to the treatment with neoadjuvant chemotherapy for ovarian cancers FIGO Stage III and IV. For the period of 1990 till 2004 - 238 patients with histological diagnosis cystadenocarcinomas were evaluated. 192 patients received conventional chemotherapy after surgical treatment and 46 patients were treated with neoadjuvant chemotherapy after which a secondary cytoreductive surgery was used. The five years survival rate for the neoadjuvant chemotherapy was the same as the five years survival rate from the conventional chemotherapy. The patients with residual tumor < or = 2 cm. had a better prognosis than those with residual tumor more than 2 cm. There was a better prognosis for the patients treated with > or = 18 mg/m2/ week cisplatin from those treated with < 18 mg/m2/week.

Advanced ovarian carcinoma as a chronic disease: a case report and review

Epithelial ovarian cancer is the fifth most common visceral malignancy in U.S. women, with the highest incidence in the sixth decade. There are often no early manifestations. Approximately 70% of patients present with advanced disease. Transvaginal ultrasonography is the single most useful test in the evaluation of a suspected pelvic mass. Treatment is based on the stage of the disease at presentation. Surgery is the mainstay of treatment. Chemotherapy is important in controlling residual disease following cytoreductive surgery and as neoadjuvant therapy in patients with advanced disease. The standard chemotherapy for advanced ovarian cancer is currently paclitaxel-carboplatin or paclitaxel-cisplatin. We present a patient who had an unusually prolonged survival after receiving ifosfamide-based combination chemotherapy. The data from the Sioux Valley Hospital USD Medical Center Cancer Registry also suggests that ifosfamide-based combination chemotherapy prolongs survival in patients with advanced ovarian cancer.

Regional celiac artery infusion in the adjuvant treatment of pancreatic cancer

We performed adjuvant celiac artery infusion in pancreatic cancer, to find out whether this treatment prolongs survival and changes the biology of the disease after resection, especially by reducing liver metastasis.

PATIENTS AND METHODS

Thirty-one patients received cyclic celiac artery infusions (CAI) after resection of their pancreatic cancer (27 ductal, 4 cystadenocarcinoma). The treatment consisted of 6 cycles (1 cycle = 5 days treatment) intra-arterial infusion using Seldingers technique with mitoxantrone A (Novantron) 10 mg/m2 d1, 5-fluorouracil + folinic acid 600 mg/m2 + 170 mg/m2 d2-d4 and cis-platinum 60 mg/m2 d5. Four to 5-week intervals between each cycle of chemotherapy were scheduled. The patients were monitored for toxicity, development of disease progression and survival.

RESULTS

The median survival time was 21 months. During an observation period of 19 months, 70% of the patients developed disease progression. In 50% of cases the progression was local, in 40% intraperitoneal while in 15% liver metastases developed. The median survival time of the CAI (celiac artery infusion)-treated patient group compared favorably to the median survival of 9.3 months in a matched historical control group, being significantly longer (p < 0.0003).

CONCLUSION

Adjuvant celiac artery infusion seemed to prolong median survival and the occurrence of liver metastases appeared to be delayed or reduced.

Primary chemotherapy in stage IV ovarian cancer. A prospective phase II study

BACKGROUND AND RATIONALE

Non-curative surgical cytoreduction of advanced tumors is associated with increased proliferation of the remaining tumor cells. Thus, appropriate preoperative chemotherapy should prevent both cell proliferation and the increase of resistant cells. The aim of the present study was to evaluate the efficacy and toxicity of primary chemotherapy (P-CT) in previously untreated patients with stage IV ovarian cancer (OC).

PATIENTS AND METHODS

Thirty-four patients with stage IV OC were treated from January 1993 to April 2000 with P-CT. Eligibility criteria included: histologically or cytologically confirmed, unresectable stage IV OC and performance status < or = 3. P-CT consisted of four courses of carboplatin, cyclophosphamide and epirubicin until October 1996, and paclitaxel, carboplatin thereafter. Surgery followed P-CT. After the operation patients received two further courses of chemotherapy that were tailored according to their individual response. Median (M) age was 61 years, range 32-73; median performance status was 2. A total number of 197 courses of CT were administered, median 5.7 per patient.

RESULTS

Complete or partial response (CR, PR) was observed in 28 patients (response rate 82%, 95% CI: 65.4% to 93.2%), disease stability and progression (SD, PD) was observed in three and three patients, respectively. Median time to progression was 16.45 months (range 4.8-90.4+), median survival time was 28 months (range 4.5 - 90.4+): 1-year survival rate was 94%. Toxicity according to WHO: nausea and vomiting grade (G) 2, 30% of patients; gastrointestinal G 2-3, 20% of patients; alopecia G 3, 88% of patients; hematological G 3-4, 73% of patients; neurologic G 2, 12% of patients. Nine pathological CRs were observed.

CONCLUSION

Neoadjuvant treatment with CBDCA with either CTX and EPI or Taxol is feasible and shows activity in OC.

[Clinical characteristics of clear cell carcinoma of the ovary]

OBJECTIVE

To study the clinical characteristics of clear cell carcinoma of the ovary.

METHODS

Forty three patients with clear cell carcinoma of the ovary and 51 patients with serous adenocarcinoma of the ovary who were admitted in Peking Union Medical College Hospital between 1984 to 2000 were analyzed retrospectively, and their chemosensitivities and the survival rates were compared.

RESULTS

The percentage of early stage patients in the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary was 14.4% and 3.8% respectively, the difference was significant (P < 0.005). In the late stage patients who underwent satisfactory cytoreductive surgery, the chemo-resistant rate (88.9%) in the clear cell carcinoma of the ovary was significantly higher than that (57.1%) of the serous adenocarcinoma of the ovary (P < 0.02), the 1-year survival rate (79.0%) in the clear cell carcinoma of the ovary was significantly lower than that (96.2%) of the serous adenocarcinoma of the ovary (P < 0.01). In the late stage patients who underwent unsatisfactory cytoreductive surgery, the chemo-resistant rate and the survival rate had no significant difference between the clear cell carcinoma of the ovary and the serous adenocarcinoma of the ovary (P > 0.05).

CONCLUSIONS

There are more early stage patients with clear cell carcinoma of the ovary. We should conduct auxiliary therapy and close follow up to them after surgery. Clear cell carcinoma of the ovary is chemo-resistant to platinum-based chemotherapy and has poor prognosis.

Potential clinical utility of CA-125 in responsive but persistent large-volume ovarian cancer following platinum-based chemotherapy

BACKGROUND

Despite the demonstrated clinical utility of the serum CA-125 antigen level in ovarian cancer, controversy exists regarding interpretation of "discordant" results between changes in this tumor marker and measurable disease masses.

CASE

A patient with ovarian cancer cared for in the Gynecologic Cancer Program of the Cleveland Clinic Foundation receiving second-line single-agent carboplatin for recurrent disease demonstrated a major response in serum CA-125, but minimal shrinkage of a large painful abdominal mass. A laparotomy was performed both to define the nature of this mass and to attempt to relieve symptoms. The mass was found to be a large "inflamed pseudotumor with central necrosis." No viable tumors cells were found.

CONCLUSION

This case represents an excellent example of the remarkably complex biology of malignant disease and suggests how evaluation of changes in CA-125 in women with ovarian cancer may be utilized in individual patients to develop optimal management plans.

Sequence-dependent cytotoxicity of combination chemotherapy using paclitaxel, carboplatin and bleomycin in human lung and ovarian cancer

Combination chemotherapy for non-small cell lung cancer (NSCLC) and ovarian cancer typically consists of a regimen of a taxane such as paclitaxel and a platinum-containing agent. Bleomycin, which halts cell cycle progression at G2 phase, is an agent which might thereby increase taxane cytotoxicity. The goal of this study was to evaluate the effect of different paclitaxel-platinum or paclitaxel-bleomycin schedules on cytotoxicity in human NSCLC and ovarian cancer cells. The simultaneous combination of paclitaxel and carboplatin exhibited simple additivity in vitro, while sequential exposure studies indicated that carboplatin followed by paclitaxel produced greater than additive cytotoxicity using the isobologram analysis of combinatorial effects. In contrast, the simultaneous combination of paclitaxel and bleomycin consistently exhibited greater than additive effects indicating a potentially synergistic combination. Sequential exposure studies of bleomycin followed by paclitaxel produced similar synergistic findings. Experiments in SCID mice evaluating the combinations of paclitaxel and bleomycin supported the in vitro results, as significantly enhanced A549 lung tumor growth inhibition was observed when paclitaxel was administered 1 h after bleomycin. The synergistic activity shown by the combination of bleomycin and paclitaxel indicates a potentially beneficial novel combination for treatment of NSCLC and ovarian cancer.

Bladder carcinoma associated with cyclophosphamide therapy for ovarian cancer occurring with a latency of 20 years

BACKGROUND

Cyclophosphamide-induced urothelium cancer of the bladder is a well-known entity. The risk for inducing such cancer grows with duration and dosage of cyclophosphamide therapy. The lag time between termination of treatment and development of urothelial cancer has been observed to be between 9 months and 11 years. Single cases have been reported 14, 16, 17, and 21 years after cyclophosphamide treatment.

CASE

We report a case of a bladder cancer occurring after a lag time of 20 years after oral therapy with cyclophosphamide for ovarian cancer. The bladder cancer was detected due to gross hematuria.

CONCLUSION

It is of great importance for gynecologists to continue to care for patients who have received long-term cyclophosphamide treatment, even if the treatment was completed decades ago. One possible early symptom of cyclophosphamide-induced bladder cancer is painless hematuria. This can easily be used to detect bladder cancer in women at risk, even after a very long latency period.

Use of docetaxel (Taxotere) in patients with paclitaxel (Taxol) hypersensitivity

Anaphylaxis or significant hypersensitivity reaction is one of the most catastrophic potential complications of chemotherapy. There is a 2-5% risk of hypersensitivity with paclitaxel, a commonly used chemotherapeutic agent for various cancers. Three patients, who developed hypersensitivity to paclitaxel infusion, received docetaxel without allergic reactions. Docetaxel may therefore be an alternative treatment for patients with paclitaxel hypersensitivity.

[Heterotopic osteogenesis in postoperative care in ovarian cancer treatment]

The case of calcification in postoperative scare in patient with ovarian cancer was described. The patient was operated because of ovarian cancer and had subsequently chemiotherapy. Afterwards the second look operation was performed which showed calcification (size 9.5 x 2 x 0.4 cm) in postoperative scare. The calcification wasn't a metastasis from the ovary. The etiology of calcification in unclear. The heterotopic osteogenesis in postoperative scars is quite rare. They usually appear as a result of calcification of connective tissue. Sometimes the relation between osteogenesis and neoplasmatic disease is supposed. Till now the reason of these kind of calcification is still unknown.

Hepatic arterial infusion chemotherapy of cisplatin for biliary cystadenocarcinoma

Biliary cystadenocarcinoma is a rare tumor which has a better prognosis after complete surgical removal. However, since there is no other effective therapeutic option instead of surgery, the prognosis is very poor if surgical resection is impossible. We report the case of a 78 year-old woman who was treated only by hepatic arterial infusion (HAI) chemotherapy of cisplatin (85 mg) because liver functional reserve was too bad to perform a major hepatectomy. Huge biliary cystadenocarcinoma occupying the right lobe of the liver measuring 12 cm in size before chemotherapy was drastically decreased to 2 cm in size 8 months after chemotherapy. Although she had abdominal pain and anorexia before chemotherapy, she is doing well and has no complaints 9 months after chemotherapy. In conclusion, an effective therapy may be possible using hepatic arterial infusion chemotherapy of cisplatin in patients with biliary cystadenocarcinoma for whom surgical treatment is not suitable.

Modulation of the multidrug resistance P-glycoprotein: detection with technetium-99m-sestamibi in vivo

Overexpression of the multidrug resistance (MDR1) P-glycoprotein (Pgp) has been documented in nearly all forms of human cancers and increased levels of Pgp in some tumors correlate with poor response to treatment. Technetium-99m-sestamibi has recently been validated as a Pgp transport substrate. Pgp is also normally expressed along the biliary canalicular surface of hepatocytes and the luminal side of proximal tubule cells in the kidney, while not expressed in heart.

METHODS

Focused on these organs with known Pgp status, we present the findings on 99mTc-sestamibi scintigraphy of three patients with refractory cancer who were imaged before and after administration of SDZ PSC 833, a second-generation, high-potency modulator of Pgp.

RESULTS

Before treatment with SDZ PSC 833, scintigraphy using 99mTc-sestamibi showed normal, prompt clearance of the radiotracer from the liver and kidneys relative to the heart. After administration of the Pgp modulator, 99mTc-sestamibi was selectively retained in the liver and kidneys.

CONCLUSION

Hepatobiliary and renal clearance of 99mTc-sestamibi are Pgp-mediated, and inhibition of Pgp transport in these organs can be successfully imaged using 99mTc-sestamibi in patients. Similar results might be expected with this and related radiopharmaceuticals for functional imaging of Pgp transport and modulation in tumors.

Regional chemotherapy with hemofiltration: a rationale for a different treatment approach to advanced pancreatic cancer

BACKGROUND/AIMS

Since 1989, thirty-two patients with advanced, intra-abdominal pancreatic cancer were treated with regional chemotherapy in combination with extracorporeal hemofiltration.

PATIENTS AND METHODS

Eleven patients had locally advanced, unresectable cancer, and ten had advanced disease with liver metastases. Three patients had developed liver metastases following a radical resection. One patient had an incomplete resection with local residual disease, and a second had developed a local recurrence after a radical resection. One patient had an unresectable cystadenocarcinoma. Five patients had failed prior systemic therapies for unresectable pancreatic cancer. The patients underwent 85 treatments with regional chemotherapy plus hemofiltration, an average of 2.7 treatments per patient.

RESULTS

Of 21 patients treated primarily with regional chemotherapy plus hemofiltration, there were two complete responses (9%) and eight partial responses (38%), an overall total response rate of 47%. The average survival for patients with Stage II/III localized, unresectable disease is 13 months and that for Stage IV unresectable disease with liver metastases is 9 months.

CONCLUSIONS

Patients with recurrent disease following a radical resection or having failed prior systemic therapies generally had no benefit from regional chemotherapy plus hemofiltration.

Successful parenteral desensitization to paclitaxel

BACKGROUND

Paclitaxel, a member of a new class of antineoplastic agents called the taxanes, has been associated with anaphylactoid reactions.

OBJECTIVE

We report a case of successful parental desensitization to paclitaxel.

METHODS

Desensitization was performed with serial 10-fold dilutions (up to 1:100,000) of paclitaxel in sufficient volume to administer successive doses of 1, 2, 4, and 8 ml. Basophil histamine release tests were performed with paclitaxel alone, vehicle alone, and paclitaxel and vehicle combined to determine which agent was responsible for the anaphylactoid reactions.

RESULTS

After parental desensitization was performed, the patient was able to tolerate infusion of paclitaxel without complications or need for antihistamines or steroids. Basophil histamine release occurred only with paclitaxel and not with the vehicle.

CONCLUSIONS

Successful parenteral desensitization to paclitaxel can be achieved; it is paclitaxel, and not its vehicle, that is most likely responsible for anaphylactoid reactions in patients undergoing treatment.

[Percutaneous drainage of refractory necrotizing tumors: experience in 9 patients]

PURPOSE

The ranking of percutaneous drainage treatment in necrolytic advanced tumours was assessed.

METHOD

9 patients with refractory symptomatic necrolytic tumours were treated for alleviation by percutaneous drainage. Additionally, an attempt to sclerose the necrotic cavity was performed in 6 patients (6 x mitoxantrone 30 mg/24 hrs, of which 1 x additionally 98% alcohol).

RESULTS

In 5 of the 9 patients symptomatic relief was obtained, but complete sclerosing of the necrotic cavity succeeded in only two patients. In two patients with necrotic tumours of the pelvis there was a bacterial superinfection of the tumour necrosis.

CONCLUSION

Percutaneous alleviation is only occasionally successful in patients with necrolytic tumours. Therapy becomes effective probably only in case of successful sclerosing of the tumorous cavity.

Prolonged intake of chlorambucil for ovarian cancer

The use of alkylating agents has been reported to be a cause of secondary leukemia particularly in patients surviving for 2 years or more after treatment of ovarian carcinoma. The risk of developing leukemia is possibly related to the duration of treatment and the total dose of alkylating agents administered. We report a patient with epithelial ovarian carcinoma who received chlorambucil for 130 consecutive months with no clinical or laboratory evidence of leukemia.

Tamoxifen modulation of cisplatin cytotoxicity in human malignancies

Recent clinical trials have indicated that addition of tamoxifen (TAM) to a combination of cisplatin (DDP), carmustine and dacarbazine markedly increases the overall objective response rate of patients with metastatic malignant melanoma. Previous studies have determined that there is remarkable synergy between TAM and DDP in a human melanoma cell line T-289. Using the technique of median effect analysis, in clonogenic assay, we observed a highly synergistic interaction between TAM and DDP. To determine whether or not this synergistic interaction was unique to human melanomas, or is generally observed in other types of malignancy, we examined the nature of this interaction using a human ovarian carcinoma and small cell lung cancer cell line. Synergy was observed in both cell lines. In the case of all 3 types of malignancy, synergy was observed at concentrations of both TAM and DDP that can be achieved in patients. Our results demonstrate that cytotoxic synergy between the DDP and TAM is observed in cell lines established from multiple types of human malignancies. It is important to note that the synergy between TAM and DDP is not dependent on the presence of estrogen or progesterone receptors. Since TAM is well tolerated by patients, it is particularly attractive as a potential agent with which to sensitize human tumors to DDP.

[Effect of rG-CSF on the morphology and function of neutrophils in ovarian cancer chemotherapy]

The combined use of rG-CSF in ovarian cancer chemotherapy prevents a decrease in the number of neutrophils and promotes their recovery. rG-CSF also protects against infections, enhancing chemotherapeutic effectiveness. It is reported that neutrophils produced by rG-CSF not only increase in number but also in function. Some clinicians, however, doubt whether neutrophils mobilized or produced by rG-CSF have sufficient ability to function practically in clinical cases. We therefore examined, by means of flow cytometry, the neutrophils' phagocytosis and bactericidal ability and we found both normal. No morphological abnormalities were seen in these neutrophils. In our observations, moreover, no effect was exerted on the leukocyte-membrane antigen. It was concluded that (a) rG-CSF was very effective in protecting against the diminution of neutrophils by chemotherapy and (b) in promoting their recovery, and (c) also the function, morphology and leukocyte-membrane antigen of these neutrophils were normal.

Modulation of sensitivity of human ovarian cancer cells to cis-diamminedichloroplatinum(II) by 12-O-tetradecanoylphorbol-13-acetate and D,L-buthionine-S,R-sulphoximine

The ability of 12-O-tetradecanoylphorbol-13-acetate (TPA) and D,L-buthionine-S,R-sulphoximine (BSO) to modulate cis-diamminedichloroplatinum(II) (CDDP) sensitivity was investigated in human ovarian cancer cell lines sensitive (KF) or with intrinsic resistance (KK and MH) to CDDP. The KK and MH cell lines were derived from ascites of patients with clear-cell carcinoma and serous cystadenocarcinoma of the ovary who both showed clinical resistance to CDDP. The CDDP IC50 value of KK and MH cells was about 4.6- and 10.2-fold higher than that of KF cells. PKC activities in the cytosol and membrane of KK and MH cells were also about 4- to 5-fold higher than those of KF cells. Proliferation of KF, KK and MH cells was inhibited in a dose-dependent manner by TPA. The membrane PKC activities in the KF cells were rapidly activated and down-regulated 24 hr after exposure to TPA, while those in the KK and MH cells were not down-regulated even after exposure to TPA for 24 hr, suggesting that the membrane form of PKC may be involved in the intrinsic resistance. Continuous exposure to 10 nM TPA for 5 days significantly reduced the CDDP sensitivity of KF and KK cells, while exposure to 10 nM TPA for 1 hr significantly elevated that of KK and MH cells. Interestingly, 1-hr exposure to 1 microM TPA induced CDDP-resistance in KK cells. Such changes in CDDP sensitivity by TPA seemed to be linked with those of cellular PKC activity, i.e., when the CDDP sensitivity was reduced by TPA, the cellular PKC rose.(ABSTRACT TRUNCATED AT 250 WORDS)

Salvage intraperitoneal therapy of ovarian cancer employing cisplatin and etoposide: a Gynecologic Oncology Group study

BACKGROUND

To further explore the potential of salvage intraperitoneal cisplatin-based therapy in patients with small-volume residual ovarian cancer a Phase II trial was conducted by the Gynecologic Oncology Group.

METHODS

Ninety-two patients entered into this trial were treated with a regimen of cisplatin (100 mg/m2) and etoposide (200 mg/m2) delivered intraperitoneally every 4 weeks for a maximum of six cycles.

RESULTS

Of the 84 patients evaluable for toxicity, grades 3-4 neutropenia, thrombocytopenia, neurotoxicity, and nephrotoxicity were observed in 25, 12, 6, and 9% of patients, respectively. A total of 41 patients were evaluable for response to the treatment program. Of the 25 evaluable patients with favorable pretreatment characteristics (prior response to systemic cisplatin or relapse > 6 months after completing initial chemotherapy), 10 (40%) achieved a surgically documented response (S-R), including 6 (24%) who achieved a surgically documented complete response (S-CR). Of the 16 patients with unfavorable pretreatment characteristics (less than a partial response to systemic cisplatin or a response of < 6 months duration) the S-R rate was only 12% (S-CR: 6%).

CONCLUSIONS

In this large multi-institutional cooperative group study, we have confirmed the activity of salvage cisplatin-based intraperitoneal chemotherapy in patients with small-volume residual ovarian cancer who have favorable pretreatment characteristics. The overall impact of these responses on disease-free and overall survival remains to be defined.

Ovarian mucinous cystadenocarcinoma with sarcoma-appearing mural nodule of anaplastic carcinoma

An ovarian mucinous cystadenocarcinoma with sarcoma-appearing solid mural nodules in an 18-year-old Japanese woman is reported. Right ovarian cyst had two poorly circumscribed, solid nodules and several tiny studs. Microscopically, the epithelial elements consisted of benign, low malignant potential and malignant mucinous tumors. The mural nodules were made up of highly malignant anaplastic cells simulating sarcoma. In one of the mural nodules, continuity between the malignant mucinous cells and sarcoma-appearing cells was identified. Immunohistochemically, the sarcoma-appearing nodule was uniformly positive for vimentin and focally positive for epithelial markers such as EMA, CAM5.2, and AE1/AE3. This case demonstrated an orderly transformation and dedifferentiation of epithelial cells to undifferentiated mesenchymal cells. Although she had stage IIb disease, she lived disease free for 3 years and 5 months after surgery followed by 10 courses of chemotherapy containing cisplatin and Adriamycin.

Clinically silent progressive renal tubulointerstitial disease during cisplatin chemotherapy

BACKGROUND

Chronic cisplatin nephrotoxicity is well documented in animal models but not well characterized in humans. The authors report a 56-year-old woman who had end-stage chronic tubulointerstitial nephropathy develop during treatment with multiple courses of cisplatin chemotherapy for ovarian carcinoma.

METHODS

A biopsy was performed to determine the etiology of renal failure, and the morphologic, immunofluorescent, and ultrastructural findings were analyzed to identify possible causes, other than cisplatin, of chronic renal disease.

RESULTS

Morphologic studies showed extensive renal tubulointerstitial fibrosis with relative sparing of glomeruli.

CONCLUSIONS

Profound, progressive renal injury occurred during cisplatin treatment despite adherence to treatment protocols designed to minimize such toxicity. Renal injury was undetected by pretreatment serum creatinine determinations. This case and others emphasize the relative insensitivity of this test for chronic renal damage during treatment with nephrotoxic drugs.

Ascites levels of haptoglobin in patients with ovarian cancer

BACKGROUND

Haptoglobin is an acute-phase reactant protein involved in immune regulation. It has been isolated from malignant ovarian ascites and has been shown to be capable of mediating nonspecific immune suppression in vitro in humans and in vivo in experimental animals. The range of concentrations under which such a nonspecific suppression is observed lies well within concentrations of haptoglobin observed in vivo. This immune suppression could adversely affect patient outcome.

METHODS

Based on this information, ascites haptoglobin levels of 21 consecutive patients with ovarian cancer who underwent initial surgical debulking were determined. After the patients received chemotherapy, they were divided into those having a positive and those have a negative second-look operation.

RESULTS

Seventeen patients with positive pathology at second look had an initial mean ascites haptoglobin level of 99 +/- 49 mg/dl. The mean haptoglobin level in the four patients with negative findings was 67 +/- 42 mg/dl. The difference in these mean haptoglobin levels is not statistically significant (P > 0.05).

CONCLUSION

Although the number of patients in this study is small, the wide range of values documented in both groups make it doubtful that an initial absolute ascites haptoglobin level will prove clinically prognostic of eventual disease status at the time of second look laparotomy.

Enhancement of antiproliferative effect of cis-diamminedichloroplatinum(II) by clomiphene and tamoxifen in human ovarian cancer cells

In this study, we examined antiproliferative effect of clomiphene and tamoxifen alone and their combined effect on cis-diamminedichloroplatinum(II) (CDDP) by using human ovarian cancer cells (KF, KK, and MH cells) with different sensitivity to CDDP and MCF-7 cells derived from human breast cancer. KF, KK, and MH cells did not have estrogen receptor while MCF-7 cells had it. The KF cells were most sensitive to CDDP followed by KK, MCF-7, and MH cells. Similarly, the KF cells among three human ovarian cancer cell lines were most sensitive to clomiphene and tamoxifen alone. The MCF-7 cells had similar high sensitivity to both clomiphene and tamoxifen. When effects of clomiphene and tamoxifen on the protein kinase C (PKC) activity in the cancer cells were examined, the degree of inhibition of the PKC activity in the KF cells by clomiphene and tamoxifen was most marked and that by clomiphene was followed by those by KK, MH, and MCF-7 cells, while that by tamoxifen was, in increasing order, MH, MCF-7, and KK cells. Analyses of effects of clomiphene or tamoxifen on concentrations of CDDP required for 50% inhibition of cell proliferation (IC50) revealed that although the combined effects, in the KF and KK cells were only marginal, marked enhancement of antiproliferative effects of CDDP on the MH cells resistant to CDDP was obtained. When 5 x 10(6) cells were incubated with 100 microM CDDP for 3 hr, uptake of CDDP by MCF-7 cells was lowest, followed by MH, KK, and KF cells. The CDDP uptake by KF and KK cells was increased about 30-40% in the presence of clomiphene or tamoxifen. The CDDP uptake by the MH cells in which most marked enhancement of antiproliferative effect of CDDP was observed by a combination with clomiphene or tamoxifen was increased about 80-90% in the presence of clomiphene or tamoxifen. These results suggest that not only tamoxifen but also clomiphene can potentiate antiproliferative effect of CDDP in the ER-negative CDDP-resistant cancer cells by enhancing the CDDP uptake.

[The value of etoposide (VP-16) in the therapy of refractory ovarian cancer]

In analogy to Kühnle et al. (1984) the role of etoposide in patients with cisplatin-refractory ovarian cancer was evaluated. 45 patients were treated with 150-200 mg of etoposide per sa. m. on days 1-3. Acute toxicity was tolerable except alopecia grade III. Remarkable, however, was the induction of two fatal cases of leukaemia following etoposide treatment. The first patient, who was 27 years old, with FIGO stage IIb serous cystadenocarcinoma, which was treated with cisplatin/epirubicin and after a latent period of 45 months, a local recurrence was treated with 8 cycles of etoposide. Twenty-three months after discontinuation of etoposide therapy, the patient showed acute myelogenous leukaemia (AML) of M5b-subtype according to the FAB classification. Two days after diagnosis, the patient died of the disease. The second patient, a 55-year old woman with FIGO stage IIa serous cystadenocarcinoma, was treated with cisplatin/cytoxan; 8 cycles of etoposide were given as a second line therapy. This patient, 21 months after discontinuation of etoposide therapy showed a pre-pre-B-acute lymphocytic leukaemia with coexpression of the myeloid antigens. Two months after diagnosis, the patient died of the disease. In 4 out of 38 patients, a complete and in 7 patients a partial remission was induced by etoposide treatment and survival of these responding patients was prolonged in comparison with the nonresponder. The survival was also dependent on CA-125 serum level and the cumulative dose of etoposide administered. Etoposide treatment is an acceptable option as salvage therapy in refractory ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

A newly synthesized bifunctional inhibitor, W-77, enhances adriamycin activity against human ovarian carcinoma cells

A newly synthesized calmodulin antagonist, (S)-P-(2-aminoethyloxy)-N-[2-(4-benzyloxy-carbonylpiperazinyl++ +)-1-(P-methoxybenzyl)ethyl]-N-methylbenzenesulfonamide dihydrochloride (W-77), acts as a calcium-independent uncompetitive antagonist which binds to glutathione-S-transferase (GST). We purified GST from human placenta using drug affinity chromatography on a column of W-77 coupled with Sepharose 6B and demonstrated that W-77 bound to GST. A spectrophotometric assay also showed that W-77 inhibited GST activity. We prepared Adriamycin-resistant and -sensitive cells from human ovarian serous cystadenocarcinomas. Immunoblot analysis revealed that GST expression was increased in the Adriamycin-resistant cells. We also purified GST from Adriamycin-resistant cells and found that W-77 bound to the GST obtained from these ovarian carcinoma cells. Adriamycin resistance was partially overcome by the addition of W-77 (10 microM) to the cultured cells. In addition, we investigated the effect of W-77 on P-glycoprotein. Northern blot analysis revealed MDR1 gene expression in Adriamycin-resistant cells. Although W-77 was less potent in increasing the intracellular Adriamycin content than verapamil, it was more effective in overcoming Adriamycin resistance. These results suggest that W-77 enhances the antitumor activity of Adriamycin by inhibiting both GST and P-glycoprotein.

Platinum chemotherapy during pregnancy for serous cystadenocarcinoma of the ovary

Ovarian carcinoma in pregnancy remains a rare event. Although concern regarding the gestation complicates therapy, platinum drug-based combination chemotherapy is often deemed warranted in such cases. We report the antepartum use of cisplatin, followed by carboplatin, for an ovarian serous cystadenocarcinoma. During this treatment, serial sonographic assessment of fetal morphometric parameters and biophysical profiles with fetal heart rate monitoring were performed to document fetal well being. Platinum-DNA adducts were measured in maternal blood, placenta, fetal amniotic cells, and cord blood. This report represents an attempt to define platinum drug transfer in utero and fetal growth and development during therapy and to document the first use of carboplatin in pregnancy.

[Antitumor effect of PSK and its combined effect with CDDP on ovarian serous adenocarcinoma-bearing nude mice]

Although the antitumor effect of PSK can be increased by potentiating the immune functions of PSK in tumor-bearing hosts, the mechanisms of its action are not fully understood. In this study, we examined the antitumor effect and CDDP combined effect of oral administration of PSK on nude mice bearing a human ovarian cancer cell line (KF cells). 1. PSK was observed to have a significant antitumor effect in tumor-bearing nude mice and subsequently to bring about an increase in the survival rate and prolongation of the life span. 2. The antitumor effect of CDDP was (but not significantly) enhanced by oral administration of PSK and the prolongation of the life span of the tumor-bearing nude mice was obtained. 3. Six weeks after tumor inoculation, no significant natural killer (NK) cell activity in spleen cells from untreated nude mice was observed. However, when PSK (100 mg/kg but not 500 mg/kg) was given every other day, significant NK activity was induced. 4. The serum immunosuppressive acid protein (IAP) value in nude mice treated with PSK alone was significantly higher than that in nude mice treated with a combination of PSK (100 mg/kg) and CDDP. These results suggest that CDDP prevents the increase in serum IAP that occurs when PSK is used and that consequently combinations of PSK and CDDP result in augmentation of antitumor effects.

Solitary recurrent metastasis of epithelial ovarian cancer in the spleen

In epithelial ovarian cancer, solitary metastasis to and recurrences in the parenchyma of the spleen are rare in the absence of apparent disease in other sites. We report four patients who developed isolated, solitary splenic parenchymal recurrences of their epithelial ovarian adenocarcinomas and underwent a splenectomy to remove the recurrent disease. They had undergone optimal cytoreductive surgery for stage III grades 2-3 serous cystadenocarcinoma of the ovary, followed by six to nine cycles of cisplatin and cyclophosphamide chemotherapy and a negative second-look laparotomy. Evidence of relapse developed 2, 4, 6, and 10 years after initial treatment. In two patients, a rising CA-125 heralded the recurrence that was subsequently documented by computed tomography (CT) of the abdomen and pelvis with a single defect noted only in the splenic parenchyma. Two others had only a defect on CT scan. Based on these findings, the otherwise healthy women underwent an exploratory laparotomy, each had a single focus of recurrent poorly differentiated disease that was found in the splenic parenchyma and a splenectomy was performed. Multiple biopsies and cytologies revealed no other evidence of microscopic disease. There was no major postoperative morbidity. Subsequently, one woman was treated with intraperitoneal cisplatin, two with intravenous carboplatin, and one declined further therapy. Three women are alive and free of disease at 6 months to 3 years. The fourth woman is alive with recurrent disease near the site of the resected spleen found 10 months postsplenectomy. Thus, splenic recurrence of epithelial ovarian cancer can occur in the absence of other demonstrable metastasis, and it can be preceded by elevation of CA-125 and an abnormal CT scan. Based on this limited experience with selected patients, splenectomy may have a role in the management of this unusual recurrence.

Clinical remission criteria for epithelial carcinoma of the ovary

After primary cytoreductive surgery 188 patients with epithelial ovarian cancer were treated with combination chemotherapy between 1986 and 1989 in the Tokai Ovarian Tumor Study Group. Clinical remission criteria were set in this study and patients were examined to determine if they were in remission or not. Forty-seven cases (25%) had no remission and 85.9% of them died within 20 months after primary surgery. Fifty-seven cases (30.3%) had a remission and a subsequent recurrence. Eighty-four cases (44.7%) had no recurrence and all are currently alive. Independent remission factors by multivariate analysis were higher stage (P = 0.018), clear-cell carcinoma (P = 0.0048), larger maximum residual tumor (P = 0.0023), and PVB therapy (P = 0.026). Independent recurrence factors were higher stage (P = 0.0012), serous cystadenocarcinoma (P = 0.0001), clear-cell carcinoma (P = 0.00409), and PVB therapy (P = 0.0499). A significantly high remission rate and low recurrence rate was achieved using PVB therapy. This criteria has value for the treatment of epithelial ovarian carcinoma. The disease-free survival rate after clinical remission was the same as that after a negative second-look laparotomy, which implies that a second-look laparotomy may be unnecessary in the management of epithelial carcinoma of the ovary.

Characterization of a human ovarian carcinoma cell line: UCI 101

A new epithelial ovarian carcinoma cell line (UCI 101) has been established from the ascitic fluids and solid tumor of a patient with progressive papillary adenocarcinoma of the ovary shown previously to be refractory to combination chemotherapy consisting of cyclophosphamide, Adriamycin, and cisplatin as well as single-agent chemotherapy of taxol and high-dose cisplatin. The UCI 101 cell line grows well with an in vitro doubling time of 24 hr. The cell line expresses the B 72.3 (Tag 72), CA125, MH99 (ESA), and E29 (EMA) cell surface antigens and AE1/AE3 cytokeratins. This cell line overexpresses (as determined by immunocytochemistry) both p-glycoprotein and the epidermal growth factor receptor. The in vitro drug response to single agents including Adriamycin, cisplatin, dequalinium chloride, etoposide, 5-fluorouracil, taxol, and tumor necrosis factor was examined. Intraperitoneal transplantation of the cells into athymic mice resulted in foci of tumor on all peritoneal surfaces including the viscera and diaphragm ultimately leading to solid bulky disease with massive production of ascites. High levels of CA125 (> 500 units/ml) were detected in the serum of tumor-bearing mice. Cytogenetic analysis of cultured cells shows several marker chromosomes containing deletions, duplications, and translocations. Cytologic and histologic evaluation of the xenograft revealed morphological characteristics identical to those of the original tumor.

[The pharmacokinetics of intraperitoneal (IP) carboplatin (CBDCA) and dose-up study of intravenous (IV) cyclophosphamide (CPM) in combination with IP CBCDA for advanced ovarian cancer patients]

The pharmacokinetics of IP CBDCA was compared with IV CBDCA and a dose-up study of IV CPM was performed in combination with 400 mg/m2 IP CBDCA for advanced ovarian cancer patients. The maximum concentration of free platinum (F-Pt) in serum following IP CBDCA administration was approximately 1/3 that of F-Pt following IV CBDCA. F-Pt in serum remained more than 90% of total platinum following IP CBDCA until 12 hours after administration. The t1/2 of F-Pt in serum after IP CBDCA administration was two times longer when compared with t1/2 following IV CBDCA, showing the slow peritoneal clearance of CBDCA. The area under curve (AUC) following IP CBDCA was approximately 67% of AUC following IV CBDCA. Cumulative urinary secretion (CUS) of platinum following IP CBDCA was 37% of CUS after IV CBDCA. The maximum tolerable dose of IV CPM in combination with 400 mg/m2 IP CBDCA was 550-600 mg/m2. The dose limiting factor of this combination therapy was leukocytopenia. Thrombocytopenia was mild in this study. Combination of 400 mg/m2 IP CBDCA and 550-600 mg/m2 seemed to be a tolerable and repeatable therapy for most patients with advanced ovarian carcinoma. Since thrombocytopenia was mild and the pharmacokinetics showed the smaller AUC of free platinum in serum following IP CBDCA, a dose-up study for IP CBDCA should be considered.

Erythromycin associated hearing loss in a patient with prior cis-platinum induced ototoxicity

A case is reported of reversible sensorineural hearing loss associated with intravenous erythromycin treatment. Cis-platinum induced high frequency hearing loss developed nine months previously during treatment for stage IV papillary cystadenocarcinoma. Renal and hepatic function were normal; however, serum erythromycin levels were elevated. Clinical recovery promptly followed discontinuation of erythromycin.

[Pharmacokinetics of carboplatin after intraperitoneal administration and clinical effect in ovarian cancer]

The patients with ovarian cancer are apt to combine peritonitis carcinomatosa (PC). The effect of intraperitoneal (IP) administration of CDDP against peritonitis carcinomatosa was examined. Hydration was not necessary when CBDCA was injected, because nephrotoxicity of CBDCA was very low compared to CDDP. We studied pharmacokinetics of IP-CBCCA and its efficacy and safety. Four hundreds and fifty mg of CBDCA was dissolved in 1,000 ml of saline and administrated through the subcutaneously implanted Infuse-A-Port for 60 minutes. Complete response was 25%. The platinum concentration in the ascites (injected saline) decreased to 90.8 micrograms/ml at 2 hr after administration and to 3.8 micrograms/ml at 24 hrs, and 79.7 97.5% existed as free Pt. The concentration of serous Pt reached to 6.2 micrograms/ml at 15 min. and was kept at 6-8 micrograms/ml. and 52.4-92.7% existed as free Pt in serum. Pt was excreted to urine and reached to the peak concentration at 4 hr. Adverse effect was mainly myelotoxicity without renal toxicity and emesis. Leukocytopenia of grade 4 was 14.3%, thrombocytopenia was 25.0%. We tried IP administration to the outpatients. The doses were mainly 300 mg, but in some cases, it was escalated to 450 mg, Adverse effect of 300 mg was thrombocytopenia of grade 4 (4.8%). These results suggest that IP administration of CBDCA seemed to be a new method as locosystemic chemotherapy. We demonstrated new chemotherapeutic method to outpatients.

[Clinical trial of China-made carboplatin in advanced ovarian cancer--an analysis of 53 cases]

Fifty three patients with evaluatable ovarian cancer were conducted a clinical trial of a new antineoplastic drug, carboplatin (cp) made in China. Apart from 1 case of stage Ic and 3 cases of stage II, all the remainders had advanced disease including stage III, IV or recurrences, and mainly consisting of epithelial carcinoma (44 cases). Thirty two patients were treated with single cp at the dose of 260-410 mg/m2 and twenty one were treated with combination chemotherapy of cp at a dose of 180-350 mg/m2 plus adriamycin and cyclophosphamide by intravenous infusion without hydration, repeated every 4 weeks, 2-4 courses. The response rate was 56% (18/32) and 48% (10/21), respectively. There were obviously different response rates in patients with previous chemotherapy (25% and 23% in cp single and combination chemotherapy groups) and without chemotherapy (67% and 88% in single and combination groups). It showed that cp was effective in treatment of ovarian cancers with advantages that gastrointestinal reaction was less severe in cp group than in the group using drugs including cis-platin, and no renal toxicity. However, cp showed more marked myelosuppression and hepatic injury in small number of the patients.

Transition from benign to malignant epithelium in mucinous and serous ovarian cystadenocarcinoma

The slides of all patients with ovarian cystadenocarcinoma treated at the University of Kentucky Medical Center from 1966-1990 were reviewed. Fifty-four serous tumors and 42 mucinous neoplasms were identified for further study. Benign epithelium adjacent to an area of borderline or malignant epithelium was observed in 74 tumors (79%) and a site of epithelial transition was noted in 38 cases (40%). The presence of associated benign epithelium was more common in borderline or well-differentiated lesions and in patients with early-stage disease. These findings are consistent with epidemiologic and molecular genetic data and suggest that certain benign serous or mucinous ovarian tumors have the potential for malignant transformation. Removal of these tumors, particularly in postmenopausal women, should result in a subsequent reduction in the frequency of ovarian cancer.

[Effect of chemotherapy on the prognosis of ovarian cancer]

Through the collaboration of 22 institutions nationwide, a total of 1,185 cases of ovarian cancer treated between January, 1980 and December, 1987, were investigated as to their prognosis from the aspect of the chemotherapeutic effect. (1) An excellent effect of the remission-induction chemotherapy was observed in a group receiving combination therapy with CDDP as the main ingredient. In particular a significant effect was seen in stages III and IV. In addition, the effect on the remaining tumors by diameter also showed a significant difference in cases of tumors of not less than 2 cm in diameter. (2) As to the effect on histological types, a comparison in stage III showed a favourable effect on endometroid, serous and mucinous adenocarcinomas, while no effect was observed in clear cell adenocarcinoma. (3) The effect of the remission induction chemotherapy did not always give rise to an improvement in the long-term prognosis of ovarian cancer, and the establishment of a therapeutic method aimed at the prevention of recurrence was desired. (4) To improve the long-term prognosis, intermittent (or cyclic) chemotherapy with CDDP as the main ingredient was found to be very effective, but maintenance chemotherapy with orally administered of 5-Fluorouracil or Tegaful was not effective. (5) The effect of the conventional immunotherapy was not observed at all.