An evaluation of the policy of routine treatment of advanced epithelial ovarian carcinoma by debulking surgery and combined platinum-cyclophosphamide chemotherapy in Singapore

This is an outcome study of a management protocol for patients with FIGO stage III and IV epithelial ovarian cancer treated by debulking surgery and combined platinum and cyclophosphamide chemotherapy. The aim of the study was to determine if the experience of clinical trials could be reproduced in a routine clinical practice in an Asian population. Of the entire group of 62 patients, 50 (80.6%) had the tumor debulked: 26 optimally and 24 suboptimally. Twelve patients had a biopsy of the tumor only. Thirty patients had a histologic grade 3 tumor. Fifty-two (83.9%) patients received the combined platinum-cyclophosphamide chemotherapy. Of these, 49 were assessable for response, and the overall response rate was 49.0%, with 20.4% complete and 28.6% partial response. The overall 5-year survival was 6.8% and the disease-free survival was 4.7% for the entire cohort. The platinum-cyclophosphamide chemotherapy responders showed a significantly better 5-year survival rate of 29.5%, compared to no survival beyond 42 months among the non-responders. Apart from nausea, vomiting and alopecia, the other toxicities of chemotherapy were mild and mostly hematological. These results showed that the management protocol of debulking surgery and combined platinum-cyclophosphamide chemotherapy could be applied routinely in more than 80% of patients with advanced epithelial ovarian cancer. Although the chemotherapy response rate was lower in this clinical study compared to other clinical trials, the overall benefit on survival appeared to be similar. It is concluded that advanced epithelial ovarian carcinoma should continue to be treated actively with debulking surgery followed by combined platinum-cyclophosphamide chemotherapy.