No new publication appeared in the past year on early stage
ovarian cancer. The current GOG study will help determine the relative benefits and toxicities of intraperitoneal P32 versus
cyclophosphamide and
cisplatin in this group of patients. Recent studies in advanced ovarian
carcinoma suggest a modest additional benefit for multidrug regimens, but
cisplatin and
cyclophosphamide remains an acceptable first line treatment for stage III and IV disease. Additional information on the use of
carboplatin in advanced disease has been published, and this agent is now accepted as part of standard first line treatment programs.
Platinum-based
chemotherapy continues to be the mainstay of treatment for recurrent disease. With the commercial availability of
taxol, a new
salvage treatment is now available.
Taxol will be increasingly studied as a part of front-line
therapy as well as its role in the salvage setting.
Altretamine and
ifosfamide appear to have activity even in some patients with
platinum-resistant disease, but these drugs will not likely have a major impact on
ovarian cancer treatment. The use of high-dose
chemotherapy with autologous bone marrow or peripheral stem cell support offers an exciting and potentially beneficial approach for patients with poor prognosis disease. The use of intraperitoneal
chemotherapy and
biologic agents continues to be problematic, and additional improvements are needed before they are considered useful outside of a research setting. With the exception of P32 for early stage disease,
radiation therapy is likely to continue to play a minor role in the treatment of
ovarian cancer. Few studies involving non-
epithelial ovarian carcinomas were published during the past year. A definitive report was published demonstrating the activity of
cisplatin-based
chemotherapy (BEP) in patients with advanced
dysgerminoma.
Chemotherapy which preserves fertility provides an effective alternative to irradiation.
Cisplatin-based
chemotherapy was active in mixed mullerian
tumors of the ovary although the prognosis of these patients was worse than patients with
epithelial ovarian cancer. Concurrent
chemotherapy added to irradiation has not improved survival over
radiotherapy alone in patients with
cancer of the uterine cervix. Patients still failed locally and distantly. Extended field irradiation to involved paraaortic lymph nodes with weekly
cisplatin generated promising pilot data. Randomized trials evaluating the use of
neoadjuvant chemotherapy prior to pelvic
radiotherapy showed no benefit and increased toxicity.
Ifosfamide alone or in combination regimens is an active
drug but with serious side effects which require careful monitoring.(ABSTRACT TRUNCATED AT 400 WORDS)