Advanced primary carcinoma of the Bartholin gland: report of 18 patients

Conservative surgery plus radiotherapy for vulvar cancer has been established as a therapeutic alternative to extensive radical surgery and produces a similar cumulative 5-year survival. We retrospectively analyzed the cases of 18 patients with advanced primary carcinoma of the Bartholin gland treated with wide local excision (WLE) or radical vulvectomy and lymphadenectomy followed by radiotherapy (RT) at the University of Texas M. D. Anderson Cancer Center from January 1978 through December 1990. All patients have been observed for a minimum of 7 months (maximum follow-up, 15 years; median follow-up, 9 years). Of the 18 patients, 7 were treated with wide local excision (WLE) followed by radiation therapy (RT) (Group 1), 9 had radical vulvectomy (RV) followed by RT to the vulvar and inguinal-femoral and pelvic node areas (Group II), and 2 were treated with RT alone after biopsy of the tumor (Group III). The 5-year disease-free survival rates were 86%, 78%, and 50% for groups I, II, and III, respectively, and 83% for the whole group. Of 2 patients treated with RT alone, one lived for 6 years with no evidence of disease, and the other lived for 20 months. The rate of local tumor control was 100% for all three treatment groups. There were no significant differences among the treatment groups in rate of primary tumor control or 5-year disease-free survival rate (p=0.1300). The present study demonstrated WLE followed by RT is the best treatment for advanced primary carcinoma of the Bartholin gland. Less radical surgery plus RT produces good long-term survival and has fewer complications.     

Squamous-cell carcinoma of the vulva: locally advanced disease

About 30-40% of vulvar cancers present with International Federation of Gynecology and Obstetrics (FIGO) (clinical) stage III or IV disease. Although surgical staging was introduced by FIGO in 1988 and hard data on this system are still relatively few, a review of our own patients suggests that this percentage of patients with advanced stage vulvar cancer probably still holds. We have considered carcinoma of the vulva to be locally advanced when the primary or recurring tumour cannot be locally managed by a radical vulvar resection. Current approaches to the treatment of locally advanced vulvar cancer include ultraradical surgery, radiotherapy, chemo-radiotherapy and a combination of treatment modalities. This chapter reviews the current approaches to the treatment of locally advanced vulvar cancer.     

The effect of centralization of primary surgery on survival in ovarian cancer patients

OBJECTIVE: To examine the effect of centralized surgery on overall survival in patients with ovarian cancer and, in particular, patients with advanced disease (stage III/IV). METHODS: In a historical prospective study design, patients referred from community hospitals to a teaching hospital for primary surgery during the 2-year period, 1995-1997, were included as cases. For each referred case, two controls, matched for International Federation of Gynecology and Obstetrics (FIGO) stage and age, were selected among patients who had had primary surgery at the referral hospitals (nonteaching) in the years, 1992-1995. Kaplan-Meier survival curves were computed and tested statistically by the log rank test. Cox proportional hazard model was applied for estimation of prognostic factors of survival. RESULTS: There was no difference in postoperative mortality for stage I/II patients by level of care (community hospitals versus teaching hospital). However, for advanced stage disease (III + IV), the controls had significantly shorter crude survival than patients who had been operated on at the teaching hospital (5-year survival: 4% versus 26%; median survival: 12 months versus 21 months) (P=.01). Multivariable analyses showed that completed chemotherapy and size of residual tumor after primary surgery were independent prognostic factors of survival. Patients optimally operated on at the teaching hospital had significantly lower risk of death compared with all other groups, independently of chemotherapy. This indicates that the extent of cytoreductive surgery and the overall management undertaken in the teaching hospital are significant predictors of improved survival. CONCLUSION: Centralization of primary ovarian cancer surgery in one health region in Norway has improved survival for patients with advanced disease. Patients with apparent advanced ovarian cancer should be referred to a subspecialty unit for primary surgery, and every effort should be made to attain as complete cytoreduction as possible.     

Cisplatin-based combination chemotherapy in carcinoma of the fallopian tube

Forty-three cases of primary tubal adenocarcinoma were treated at Memorial Sloan-Kettering Cancer Center between 1979 and 1989. Thirty-eight patients who received cisplatin-based combination chemotherapy following primary surgery were reviewed. The mean patient age was 59 years, with 86% postmenopausal. Distribution by stage was as follows: I, 3 (7%); II, 4 (11%); III, 27 (71%); and IV, 4 (11%). Median follow-up from the time of diagnosis was 62 months (range, 5-132). Overall survival for all 38 patients by Kaplan-Meier analysis was 51% at 5 years. Excluding stage I, patients with no residual disease following surgery had a significantly higher 5-year survival (83%) than those left with gross residual disease (28%). Twenty-six patients underwent a second-look procedure. Of the 21 patients with advanced (stages III, IV) disease undergoing reexploration, 11 (52%) had a negative second-look and 10 (48%) were positive. Ten of the eleven patients with a negative second-look remain clinically free of disease with a median follow-up of 49 months. One patient with stage III disease had recurred after 47 months. Carcinoma of the fallopian tube appears to respond favorably to cisplatin-based multiagent chemotherapy. Patients with advanced-stage disease who achieve a negative second-look appear to have an improved possibility of remaining disease-free over similar-stage patients with ovarian cancer.     

Long-term follow-up of patients with advanced ovarian cancers treated with intermittent administration of combination chemotherapy with cisplatin, doxorubicin and cyclophosphamide

Despite high primary response rates with cisplatin-based combination chemotherapy, the overall survival rate for advanced ovarian cancers remains dismal. We designed a new systematic treatment approach with a combination chemotherapy consisting of cisplatin, doxorubicin and cyclophosphamide (cyclic PAC chemotherapy), with the aim of improving survival rates with minimal disturbance of quality of life. Cyclic PAC chemotherapy is a three-step chemotherapy with three courses of the PAC regimen in each step. A total of nine courses with a 3-month drug-free period between each step were administered over a 15-month period to patients with clinical stage IC-IV ovarian cancer who had undergone cytoreductive surgery. Forty-eight patients with stage IC-IV disease (34 patients with stage III and IV disease) were treated with cyclic PAC chemotherapy. Thirty-four patients with stage IC-IV disease (23 patients with stage III and IV disease) were treated by a brief course of PAC chemotherapy. Long-term survival and toxicity were evaluated for both treatment groups. Cyclic PAC chemotherapy improved the overall outcome of patients (66.6% 3-year and 56.5% 5-year survival rates) compared to brief PAC (41.2% 3-year and 23.5% 5-year survival rates) ( P < 0.01). The outcome of patients with stage III-IV ovarian cancer of the cyclic PAC group (52.6% 3-year and 37.2% 5-year survival rates) was also superior to that of the brief PAC group (21.7% 3-year and 8.7% 5-year survival rates). Generally, the treatment was well tolerated. The toxicity was similar in both groups, although myelosuppresion and neurotoxicity were rather prominent in the cyclic PAC group. Cyclic PAC chemotherapy may lead to improved survival in advanced ovarian cancer, and merits further investigation in a randomized study.     

Treatment failure in vaginal cancer.

OBJECTIVE: The aim of this study was to analyze the pattern of treatment failure in patients with vaginal cancer. METHODS: Fifty-one patients with primary vaginal cancer (registered between 1957 and 1995) were reviewed. Primary treatment consisted of surgery in 12 patients and radiation in 39 patients. In these patients, the prognosis and treatment failure were analyzed in relation to clinicopathological factors. RESULTS: The 5-year survival rate was 100% in stage 0 (N = 5), 82% in stage I (N = 11), 70% in stage II (N = 23), 0% in stage III (N = 5), 14% in stage IV (N = 7), and 61% overall (N = 51). Although early disease had a relatively favorable prognosis, two of five patients with stage 0 disease developed local recurrence. There was no site-related difference in survival, but survival was better when the tumor occupied less than one-third of the vaginal wall compared with more than one-third. All relapses in stage 0-II patients were local recurrences, whereas treatment failure in stage III-IV patients was due to either persistent local disease or new distant metastasis. CONCLUSION: The present findings suggest that more intensive local therapy may achieve a better prognosis for patients with early disease. Conversely, suppression of distant metastasis along with aggressive local control is needed for advanced disease. Conventional radiotherapy alone is of little value for advanced disease.     

Optimal debulking targets in women with advanced stage ovarian cancer: a retrospective study of immediate versus interval debulking surgery

ObjectiveThe objective of this study was to examine both overall and disease-free survival of patients with advanced stage ovarian cancer after immediate or interval debulking surgery based on residual disease.MethodsWe performed a retrospective chart review at the Tom Baker Cancer Centre in Calgary, Alberta of patients with pathologically confirmed stage III or IV ovarian cancer, fallopian tube cancer, or primary peritoneal cancer between 2003 and 2007. We collected data on the dates of diagnosis, recurrence, and death; cancer stage and grade, patients’ age, surgery performed, and residual disease.ResultsOne hundred ninety-two patients were included in the final analysis. The optimal debulking rate with immediate surgery was 64.8%, and with interval surgery it was 85.9%. There were improved overall and disease-free survival rates for optimally debulked disease (< 1 cm) with both immediate and interval surgery (P < 0.001) compared to suboptimally debulked disease. Overall survival rates for optimally debulked disease were not significantly different in patients having immediate and interval surgery (P = 0.25). In the immediate surgery group, patients with microscopic residual disease had better disease-free survival (P = 0.015) and overall survival (P = 0.005) than patients with < 1 cm residual disease. In patients who had interval surgery, those who had microscopic residual disease had more improved disease-free survival than those with < 1 cm disease (P = 0.05), but they did not have more improved overall survival (P = 0.42). Patients with microscopic residual disease who had immediate surgery had a significantly better overall survival rate than those who had interval surgery (P = 0.034).ConclusionIn women with advanced stage ovarian cancer, the goal of surgery should be resection of disease to microscopic residual at the initial procedure. This results in improved overall survival than lesser degrees of resection. Further studies are required to determine optimal surgical management.     

Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary

Treatment results of 26 patients with squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary were analyzed. Four nulliparous patients with stage Ia tumors underwent conservative salpingo-oophorectomy. Following surgery, 2 patients had successful pregnancies. The remaining 7 patients with stage Ia tumors were observed after hysterectomy and bilateral salpingo-oophorectomy. Fifteen patients with stage Ic–IV tumors underwent cytoreductive surgery followed bycis-platinum-based chemotherapy with or without sequential radiotherapy. The mean survival was 63.9 months. The overall actuarial disease-free survival at 2 years was 69%, and by stage was as follows: stage I, 100% (13/13); stage II, 100% (2/2); stage III, 30% (3/10); and stage IV, 0% (0/1). A significant difference in disease-free survival was noted in stage (P= 0.0001). Optimal versus suboptimal operation was associated with a median Kaplan–Meier survival of 65 months versus 34.8 months, with actuarial disease-free survival at 2 years of 60 and 0%, respectively (P= 0.0210). Our study shows that 67% (16/24) of the patients had SCC antigen levels exceeding 2 ng/ml, which by stage was as follows: stage I, 5/11 (45%); stage II, 1/2 (50%); stage III, 9/10 (90%); and stage IV, 1/1 (100%). After completion of treatment, all 8 patients with recurrent lesions had reelevated SCC antigen levels in series SCC antigen monitoring. In conclusion, positive prognostic factors of disease-free survival were optimal cytoreduction and lower FIGO stage. We suggest that multimodality therapy, including aggressive cytoreduction followed bycis-platinum-based chemotherapy with or without sequential radiotherapy, is recommended. In addition, we suggest that serum SCC antigen monitoring may be helpful in early detection of cancer recurrence.     

Complications following combined surgery (radical vulvectomy versus wide local excision) and radiotherapy for the treatment of carcinoma of the vulva: report of 73 patients

Cancer of the vulva is uncommon, accounting for only 5% of all gynecologic malignancies, and usually occurs in women over 60 years of age. The historic treatment of choice for invasive squamous cell carcinoma of the vulva is radical vulvectomy with bilateral inguinal lymphadenectomy, which has produced excellent long-term survival. We retrospectively analyzed the complications of wide local excision plus postoperative radiotherapy compared with those of radical vulvectomy and bilateral lymphadenectomy plus pre-or postoperative radiotherapy in 73 patients with vulvar cancer. There were no significant differences among these treatments in terms of primary tumor control, 5-year disease-free survival, and overall survival. Based on these results, the best treatment alternative for advanced vulvar cancer is wide local excision plus radiotherapy, as this method retains the high survival of traditional therapy but has less morbidity.     

Treatment and survival for women with Fallopian tube carcinoma: a population-based study

OBJECTIVE: The objective of this study was to evaluate treatment and survival for women with fallopian tube carcinoma in a population-based data set. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we identified 416 women with fallopian tube carcinoma diagnosed between 1990 and 1997. We analyzed treatment and 5-year relative survival. We also compared survival to that of 9032 women with epithelial ovarian cancer diagnosed between 1991 and 1997. RESULTS: Almost half of those diagnosed with stage I/II disease did not undergo surgical evaluation of lymph nodes. Most women with stage I/II disease were treated with surgery alone, while most women with stage III/IV disease were treated with surgery and chemotherapy. Five-year relative survival by FIGO stage was as follows: stage I (N = 102), 95%; stage II (N = 29), 75%; stage III (N = 52), 69%; stage IV (N = 151), 45%. CONCLUSIONS: We observed better survival, stage by stage, for women with fallopian tube carcinoma than for women with epithelial ovarian cancer in this population-based data set. It is possible that some patients with advanced, bulky carcinoma arising in the fallopian tube may have been classified as having ovarian or primary peritoneal cancer. Women with fallopian tube cancer should be treated in accordance with the same guidelines for surgical staging, debulking, and adjuvant chemotherapy as for women with epithelial ovarian cancer. Further studies, both laboratory and clinical, are needed to delineate the differences between fallopian and ovarian cancers.     

Predictors of suboptimal surgical cytoreduction in women treated with initial cytoreductive surgery for advanced stage epithelial ovarian cancer

OBJECTIVE: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. STUDY DESIGN: All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS. RESULTS: Twenty-nine women (52%) had optimal cytoreduction (OC), and 27 (48%) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA-125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093). CONCLUSION: A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.     

The effect of adjuvant chemotherapy versus whole abdominopelvic radiation on the survival of patients with advanced stage uterine papillary serous carcinoma

OBJECTIVES: To compare the outcomes of stage III and IV uterine papillary serous carcinoma (UPSC) patients treated with platinum-based chemotherapy (PC) versus whole abdominopelvic irradiation (WAPI) after optimal cytoreductive surgery. METHODS: Surgically staged patients with advanced stage UPSC diagnosed between 1981 and 2002 were identified from tumor registry databases at four hospitals. Survival analyses and predictors of outcome were analyzed using Kaplan-Meier methods. RESULTS: Of the 40 patients with advanced UPSC (median age: 64.5), 84% were Caucasian, 8% were African American, and 8% were Asian. The majority of patients (85%) presented with vaginal bleeding. Twenty-seven had stage III and 13 had stage IV disease. All patients were optimally debulked; 21 patients received adjuvant PC while 19 underwent WAPI. The median follow-up was 27 months (range: 5-209). The 3-year overall survival (OS) and progression-free survival (PFS) for the patients with stage III disease were 49% and 37% compared to 37% and 31% in those with stage IV disease (P = 0.23 for OS; P = 0.41 for PFS). Women who received PC had a 3-year OS and PFS of 43% and 31% compared to 45% and 41% in those receiving WAPI, respectively (P = 0.40 for OS; P = 0.84 for PFS). CONCLUSION: Platinum-based chemotherapy or whole abdominopelvic irradiation resulted in similar survival in this series of women with optimally cytoreduced UPSC. Given the overall poor prognosis of these patients, new treatment modalities are warranted.     

Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer

OBJECTIVE: The aim of the study was to evaluate the effect of additional radiotherapy after chemotherapy on the relapse-free and overall survival rates of patients with advanced ovarian cancer. METHODS: Between 1985 and 1992 64 patients with radically operated ovarian cancers (4 stage IC, 2 stage II, 54 stage III, and 4 stage IV) were enrolled in a randomized study. Radical surgery comprised total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and pelvic and paraaortic lymphadenectomy. All patients received adjuvant chemotherapy with carboplatin IV 400 mg/m2, epirubicin IV 70 mg/m2 on day 1 and prednimustine orally 100 mg/m2 on days 3 to 7 at 1-month intervals. Thirty-two patients without residual disease were randomized to whole abdominal radiation (30 Gy, administered over 4 weeks). An additional 21.6 Gy were delivered to the pelvis and 12 Gy to the paraaortic region up to the diaphragm for total doses of 51.6 and 42 Gy, respectively. Cancer-related survival was calculated with the Kaplan-Meier and Cox proportional hazards methods. RESULTS: The relapse-free and overall survival rates of patients who received adjuvant chemoradiotherapy were significantly higher than those of patients who received adjuvant chemotherapy only (68% vs 56% at 2 years and 49% vs 26% at 5 years, P = 0.013, and 87% vs 61% at 2 years and 59% vs 33% at 5 years, P = 0.029). The differences were most pronounced in patients with stage III disease (77% vs 54% at 2 years and 45% vs 19% at 5 years, P = 0. 0061, and 88% vs 58% at 2 years and 59% vs 26% at 5 years, P = 0. 012). Toxicities were acceptable. CONCLUSION: Sequential combination of platinum-based chemotherapy with open-field abdominal radiotherapy is a promising adjuvant regimen for patients with advanced ovarian cancer.     

Primary adenocarcinoma of the cervix: treatment and results

Between 1972 and 1983, 49 patients with adenocarcinoma of the cervix were treated in four ways: (i) radiotherapy alone, (ii) pre- or postoperative radiotherapy and a total abdominal hysterectomy and bilateral salpingo-oophorectomy, (iii) Wertheim's hysterectomy, and (iv) pre- or postoperative pelvic radiotherapy and Wertheim's hysterectomy. The 5-year survival results for patients with FIGO Stage I disease was 90%; with Stage II disease 60%; with Stage III disease 11% and none survived with Stage IV disease. All the patients, except one (Stage III), with well-differentiated tumours are alive and disease-free, irrespective of the type of treatment they received whereas only one patient out of the 13 who had poorly differentiated tumour is alive and disease-free. Three patients had bowel damage, one after radiotherapy alone and two after Wertheim's hysterectomy and postoperative radiotherapy. No major surgical complications occurred in this series.     

Impact of re-excision of residual adjacent vulvar intraepithelial neoplasia (VIN III) and histological tumour-free margin (hTFM) on survival in primary squamous cell carcinoma of vulva

Background

hTFM in primary vulvar cancer is an important prognostic factor. Ideally, a diameter of?>?8 mm should be achieved after primary surgery. The role of VIN III persistence after primary surgery in vulvar cancer is still unclear. The main objective of the current study was to study the role of residual VIN III re-excision and compare differences in disease-free survival among patients with different hTFM and in primary vulvar cancer.

Methods

Forty-two patients with residual adjacent VIN III after primary surgery for vulvar cancer which were operated between 2000 and 2016 in our clinic were enrolled in this retrospective study. Re-excision rates for residual adjacent VIN III were calculated. According to the histological margin patients were divided into three group:?<?3, 3–8 and?>?8 mm. Univariate and multivariate analyses were conducted using the Kaplan–Meier method and Cox proportional hazards models, respectively.

Results

The vast majority of patients had pT1b stage (57.1%), grading G2 (71.4%) and lymph node-negative (45.3%) disease at first diagnosis. The re-excision rate was 57.1%. The 5-year disease-free survival (DFS) rates in patients with?<?3, 3–8 and?>?8 mm hTFM were 50.0, 50.0 and 81.0%, respectively (p?=?0.032). The 5-year DFS rates in patients with re-excision and without re-excision for VIN III were 77.3 and 52.9%, respectively (p?=?0.060). In univariate analysis was solely hTFM?>?8 mm a prognostic factor for DFS (p?=?0.017).

Conclusions

hTFM may be a potential prognostic indicator for DFS in vulvar cancer patients. Re-excision for residual adjacent VIN III could not be established as a prognostic factor for DFS after primary surgery in squamous cell cancer of vulva.

     

Is there a survival benefit to adjuvant radiotherapy in high-risk surgical stage I endometrial cancer?

OBJECTIVE: The aim of this study was to examine the effects of therapeutic modalities on survival of stage I endometrial cancer and also to evaluate the surgical morbidity and the prognostic importance of surgicopathological variables. METHODS: A hundred and ninety-six stage I endometrial cancer patients treated at Hacettepe University Hospital between 1982 and 1997 were included. After initial diagnosis all patients underwent surgical procedures including peritoneal cytology, infracolic omentectomy, total abdominal hysterectomy, bilateral salphingoopherectomy, and complete pelvic-paraaortic lymphadenectomy. The mean age at initial diagnosis was 56 years (SD = 9.9 years) and the patients were followed 3-18 years (median, 8 years). All patients had endometrioid carcinoma. Stage IC and/or grade 3 tumors were considered high-risk factors and by this definition 147 (75%) patients were low risk and 49 (25%) patients were high risk. Forty-nine percent of high-risk patients received adjuvant radiotherapy compared with 3.5% of patients in the low-risk group. RESULTS: The 10-year disease-free and overall survival rates of the entire group were 97 and 98%, respectively. Ten-year overall survival rate for the low-risk group was 100% compared with 94% for patients with high-risk features (P = 0.002). The 10-year disease-free survival rate in the high-risk group was 96% for 24 patients who received adjuvant radiotherapy versus 92% for 25 patients who did not receive adjuvant therapy (P = 0.53). Only high grade was a significant predictor of poor survival (P = 0.0004). Overall surgical morbidity rate was 8.1% without mortality related to surgery. CONCLUSIONS: Surgical staging achieved excellent survival for stage I endometrial cancer patients without incurring untoward morbidity and mortality. No survival advantage of adjuvant radiotherapy was detected even for high-risk patients, so we suggest the use of radiotherapy may be reserved for relapse.     

Carcinoma of the cervix in young females (35 years, and younger)

This retrospective study involved 55 patients, 35 years old or less with invasive carcinoma of the cervix. There were 49 squamous carcinomas, 3 adenocarcinomas, and 3 unusual varieties. Thirty-five patients had stage IB disease; 4 had stage IIA disease; 6 had stage IIB disease; 5 had stage IIIB disease, and 3 had stage IV disease. Treatments employed were either radical hysterectomy and node dissection, irradiation, or irradiation followed by radical surgery. Our overall 5-year disease-free survival among young females with stage IB disease was observed to be only 43%; stage IIA only 25%; stage IIB only 17%, and no survivors in more advanced stages.     

Primary treatment of cervical carcinoma. Ten years experience from one Norwegian health region

OBJECTIVE: To study the primary care of cervical carcinoma with regard to clinical and pathological factors, treatment decisions, complications and survival. DESIGN: A historical cohort comprising all women hospitalized with invasive cervical carcinoma (n=293) during the period 1987-1996. RESULTS: Median age was 52 years (range 23-90). FIGO stage distribution was 62%, 15%, 18% and 5% in stages I, II, III and IV, respectively. Early stage disease correlated with young age. Histologic types were: squamous cell carcinoma 84%, adenocarcinoma 11%, adenosquamous carcinoma 4% and small cell/anaplastic carcinoma 1%. Primary therapies were: surgery 188 women (64%), radiotherapy 99 women (34%), chemotherapy two women (0.7%); four women not treated (1.3%). Complications after surgery in 25 women (13%), none were fatal. Acute or late complications after primary or postoperative radiotherapy in 39 women (25%), seven (4.6%) were late serious complications. Three women died from complications related to radiotherapy. Mean follow-up of surviving patients was 58 months. Overall disease specific five-year survival was 70%. Five-year survival in stages IA, IB, II and III was 100%, 88%, 58% and 20%, respectively. One-year survival in stage IV was 31%. Median survival in stages III and IV according to curative or palliative aim of treatment was 20 and 6 months, respectively (p<0.005). CONCLUSION: Satisfactory quality of diagnosis and therapy have been maintained through regional care for cervical cancer patients.     

Survival and prognostic factors of women with advanced ovarian cancer and complete response after a carboplatin-paclitaxel chemotherapy

OBJECTIVE: We evaluated the characteristics and determinants of 5-year survival in ovarian cancer patients with complete response after first line treatment who entered a randomised study comparing two different chemotherapeutic schedules. METHODS: This analysis included 232 ovarian cancer patients with complete response after first line surgery and chemotherapy coming from a large randomised trial comparing the effect of different doses of paclitaxel combined with fixed doses of carboplatin. RESULTS: The 5-year overall survival in patients was 57.3%. The difference in 5-year survival for age <52 years (65.1%), 53-62 (51.4%) and > or = 63 (51.2%) was statistically significant (P = 0.048). The 5-year overall survival rates were 64.6% for stage III and 57.9% for stage IV. Serous and clear cell histotypes had a worse 5-year overall survival (51.5% and 50.8% respectively), while the endometrioid and mucinous had 67.1% and 71.4%: these differences were statistically different (P = 0.04). Women with residual tumour of 1 cm or smaller after primary surgery had better 5-year survival rates: 71.2% for patients with residual tumour < or = 1 cm and 46.9% for residual tumour >1 cm: these differences were statistically significant (P < 0.006). CONCLUSION: This study shows that in women with ovarian cancer and complete response after first line surgery and chemotherapy, age, histotype and residual tumour after surgery are determinants of 5-year overall survival.     

A prospective, randomized, national trial for treatment of ovarian cancer: the role of chemotherapy and external irradiation

A prospective, randomized, national trial for comparing the effects of cytotoxic agents and radiotherapy on survival in primary epithelial ovarian cancer stages I-IV was carried out in 363 patients. After laparotomy, the patients were staged according to disease spread and randomized into treatment groups within each stage. The single or combined cytotoxic agents used were: cyclophosphamide (C) and vincristine (V); 5-fluorouracil (F) and dactinomycin (D) and V; treosulfan (T); and CF. In stages I, II and III there was one treatment group receiving external irradiation; in stage IV only different cytostatics were used. It was found that, in stage I, surgery alone was superior to surgery +CV or surgery + irradiation. In stage II disease, no differences in survival between treatment groups receiving pelvic irradiation or FDV, and in stage III between whole abdomen + pelvic irradiation or CV or FDV were found. In stage IV, FDV, T and CF were of similar, poor efficacy. The authors conclude that in stage I pelvic irradiation or combined chemotherapy do not improve survival. In advanced disease, chemotherapy may be better tolerated and thus preferable to whole abdomen irradiation; the combination of more modern cancer drugs with the ones used in this study is probably likely to improve the treatment results.