CHEMOTHERAPY
For patients with small-volume persistent or recurrent disease confined to the peritoneal cavity, intraperitoneal chemotherapy may be a reasonable regimen. With large tumors (> 1 cm) or with disease located outside the peritoneal cavity, systemic chemotherapy should be considered. Patients who respond to platinum often can be retreated with one of the platinum compounds alone or in combination with other agents. The longer the disease-free interval from their primary chemotherapy, the better their chances of response; patients who have a disease-free interval of 2 years or more respond at a rate similar to that of newly diagnosed patients.
Patients who are platinum resistant and have not received paclitaxel should be treated with systemic paclitaxel. Administration of paclitaxel has resulted in a 30-35% response rate as salvage therapy and a 25-30% response rate as salvage therapy in patients resistant to platinum therapy. Other drugs for which modest response rates have been reported are topotecan, ifosfamide, hexamethylmelamine, and low-dose oral etoposide (VP-16). All patients who require salvage therapy for epithelial ovarian cancer should be considered for clinical trials.
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Radiation Therapy. The role of irradiation in the management of ovarian cancer remains controversial. There is little doubt that patients with early-stage ovarian cancer or microscopic residual advanced epithelial ovarian cancer can be cured with whole-abdominal radiation therapy. A review of the literature demonstrates survival rates that are not substantially different from those obtained with modern multidrug chemotherapy (Table 12). Although there has never been a randomized trial of modem multidrug chemotherapy and whole abdominal radiotherapy, few centers use radiotherapy as primary treatment for epithelial ovarian cancer. Most specialists believe that the complication rates are higher with irradiation; however, the lack of a randomized trial does not allow that conclusion to be established.
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Radiation therapy may be used as palliative therapy for selected patients who are symptomatic from localized disease and for whom conventional chemotherapy has failed. Examples of such palliative therapy are the control of vaginal bleeding for cancer metastatic to the vagina and temporary control of persistent pelvic disease in an attempt to avoid a colostomy. Such therapy is palliative, however, because the spread pattern of the disease makes it unlikely that there are no metastases outside of the pelvis.
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TABLE 12. Long-Term (5-10-Year) Survival in Ovarian Carcinoma Patients Treated with Whole Abdominal
Irradiation: Correlation of Survival with the Size of Tumor After Initial Surgery
No. with No. with Minimal No. with Large
Residual Tumor Residual Tumor Residual Tumor
Author Year (% Surviving) (% Surviving) (% Surviving)
Dembo 1985 46 (48) 55 (43) 71 (18)
Martinez et al 1985 30 (68) 42 (54) 54 (20)
Fuller et al 1987 20 (77) 12 (62) 10 (0)
Macbeth et al 1988 57 (57) – -
Goldberg and Peschel 1988 60 (77) 14 (7) -
van Bunningen et al 1988 85 (75) – -
Weiser 1988 37 (59) 24 (42) 23 (10)
Lindner et al 1990 63 (65) 10 (40) -
Mean survival 65% 41% 12%
[...] is not indicated unless the goal is to resect residual cancer completely. It is best to begin chemotherapy as soon as possible because tumors recur and grow [...]
[...] study from England that looked at the utility of giving radiation to these masses after chemotherapy. This is a study of 302 consecutive men with metastatic seminoma, treated with chemotherapy. Over [...]