Harry Brenner

Abdominopelvic irradiation for stage II–IV ovarian carcinoma patients with limited or no residual disease at second-look laparotomy after completion of cisplatinum-based combination chemotherapy

Abdominopelvic irradiation was given to 18 stage II-IV ovarian carcinoma patients who completed cisplatinum-based combination chemotherapy, were in complete clinical remission, and who underwent second-look laparotomy. The survival as well as the progression-free interval (PFI) was significantly longer in patients with a negative second-look laparotomy than in those with limited residual disease at this operation. Abdominopelvic irradiation was not effective in patients with limited residual disease at second-look laparotomy (3 year survival--34.3% and median PFI from second-look laparotomy--4.8 months). Even in patients with a negative second-look laparotomy the median PFI was only 13 months from this operation and the 3-year survival was 87.5%. The results were similar to other comparable series in which no treatment was administered to patients with a negative second-look laparotomy.

Intraperitoneal cisplatin chemotherapy versus abdominopelvic irradiation in ovarian carcinoma patients after. Second‐look laparotomy

The current study compares the outcome within 3 years after diagnosis in two groups of histologically confirmed Stage II‐IV ovarian carcinoma patients in complete clinical remission with minimal or no residual disease at second‐look laparotomy, performed after completion of cisplatin‐based combination chemotherapy. One group (n = 18) received after reexploration abdominopelvic irradiation (RT group), the other, diagnosed during a later period (n = 19), received three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection (IP group). The two groups were comparable with regard to age, stage at diagnosis, histologic category, grade of differentiation, size of residual tumor after the initial operation, and rate of negative second‐look laparotomy. The overall survival probability after diagnosis was significantly better in the IP group, the maximal difference being observed at 36 months: 76.6% versus 44% in the RT group (P = 0.04). This difference was mainly evident in patients with a negative second‐look laparotomy in whom the respective survival probabilities were 100% versus 70% (P = 0.04). Survival was significantly shorter (P < 0.01) in patients with a positive second‐look, and there was a nonsignificant trend for better survival in the IP group. Significantly improved probability of progression‐free interval after diagnosis was also found in the IP group, the maximal difference being observed at 22 months: 78.3% as compared to 50.9% in the RT group (P = 0.04). This difference was again limited to patients with negative second‐look, the respective values being 100% versus 60% (P = 0.04). Our retrospective data suggest an apparent advantage to intraperitoneal cisplatin treatment in these patients which should be further explored for definite evaluation.

Intraperitoneal cisplatin chemotherapy in ovarian carcinoma patients who are clinically in complete remission

Three courses of intraperitoneal cisplatin chemotherapy with systemic thiosulfate protection were administered to 31 stage II-IV ovarian carcinoma patients who were clinically in complete remission after completion of postoperative cisplatin-based combination chemotherapy. The 5-year survival rate was 60.4% and the median progression-free interval 35 months. Among 25 patients who underwent second-look laparotomy, the survival and the duration of the progression-free interval were significantly better in those with a pathologically confirmed complete response. Short-term intraperitoneal cisplatin chemotherapy should be considered for consolidation of treatment in ovarian carcinoma patients who are clinically in complete remission.

Intraperitoneal chemotherapy versus no treatment in patients with ovarian carcinoma who are in complete clinical remission

Background. The optimal management of patients with ovarian carcinoma who are in complete clinical remission after completion of postoperative cisplatin‐based chemotherapy has not been established.

A comparison of low- and high-dose cisplatin-based combination chemotherapy as initial postoperative treatment in advanced ovarian adenocarcinoma

Cyclophosphamide, Adriamycin, and cisplatin were given as the initial postoperative treatment to 35 patients with Stages II through IV ovarian cancer of epithelial origin during two time periods. During the first period the dose of cisplatin was 60 mg/m2 and during the second period it was 120 mg/m2, while the dose of cyclophosphamide and Adriamycin remained unchanged. No differences with regard to survival, progression-free interval, rate, and outcome of second-look laparotomy between 18 consecutive patients who received the low-dose and 17 consecutive patients who received the high-dose cisplatin were observed. The complication rate was significantly higher in the high-dose treatment group. Low-dose cisplatin-based combination chemotherapy seems therefore to be the preferable initial postoperative treatment.

A comparison of postoperative radiotherapy with postoperative chemotherapy in stage II–IV ovarian cancer patients

A retrospective comparison between 28 stage II-IV ovarian cancer patients who received postoperative abdominopelvic irradiation and 15 such patients who received postoperative cis-platinum, Adriamycin, and Cytoxan chemotherapy was made. In both treatment groups there was a trend for a longer progression-free interval and 3-year survival in patients with residual tumor masses of less than 2 cm in diameter. In these patients there was also a trend favoring radiotherapy. However, all differences were not significant. Criteria for the choice of either modality of postoperative therapy of ovarian cancer patients remain to be determined. Nevertheless, the efficacy of both modes of treatment does not differ greatly.

Extraperitoneal metastases after intraperitoneal chemotherapy of ovarian cancer patients with a negative second-look laparotomy.

The site of the first detectable recurrence was recorded in 17 consecutive stage II–IV ovarian carcinoma patients who, after a negative second-look laparotomy, received intraperitoneal chemotherapy with cisplatin and thiosulfate kidney protection. Although the progression-free interval and survival were favorable, 11 patients eventually had a recurrence and in six (54.5%) of these it was extraperitoneal. Brain metastases were detected in three patients. The appearance of extraperitoneal metastases is not always ominous.

Detection efficiency of colorectal carcinoma recurrence using technetium pertechnetate-anti-carcinoembryonic antigen monoclonal antibody BW 431/26

Background. A new anti‐carcinoembryonic antigen (CEA) antibody, BW 431/26 (Scintimun, Behring‐Werke, Marburg, Germany), labeled with technetium pertech‐netate (Tc‐99m), is an intact immunoglobulin G1 monoclonal antibody that has been used to image colorectal cancer (CRC). This report is part of a prospective multicenter clinical trial initiated by the International Atomic Energy Agency to evaluate the role of this antibody in radioimmunoimaging of patients with suspected disease recurrence.

Response to Second Line Chemotherapy in Ovarian Cancer of Epithelial Origin

Abstract Among 45 patients with stage II, III and IV ovarian cancer of epithelial origin, a good response to second line chemotherapy (SLC) was observed in 7 (15.6%) . No correlation was found between the response rate and histological category. No statistically significant correlation was found between response to primary chemotherapy and SLC. A better response to SLC was observed in state II patients and in patients in stage III and IV who underwent total abdominal hysterectomy and bilateral salpingooophorectomy compared to those who underwent a less extensive procedure. The survival of responders to SLC was significantly higher than that of non-responders.

High-dose chemotherapy and autologous stem cell transplant in women with de novo chemosensitive metastatic breast cancer.

The prognosis of patients with de novo stage IV breast cancer seems to be similar to that of patients with metastatic disease. Because these patients have not been exposed to prior therapy, the use of high dose chemotherapy (HDCT) may be beneficial. Twenty-four newly diagnosed (median age 42) responding metastatic breast cancer patients underwent HDCT (Stamp V) and stem cell support as their initial treatment. The predominant sites of metastatic disease were bone (12), lung (5), liver (2), lymph nodes (6), marrow (4), and soft-tissue (1). Estrogen/progesterone receptors were positive in 35%, negative in 45%, and unknown in 20%. Before transplantation, 10 patients were in complete remission (CR), 6 were in partial remission (PR), and 8 were inevaluable. Radiotherapy was administered to sites of documented metastatic disease. Tamoxifen was given to patients with receptor positive and unknown tumor status. After a median follow-up of 60 months from diagnosis (range 42 to 96 months), 15 patients have relapsed and 10 died. Mean and median progression free survival from transplant are 53 (SE 6.6, CI 40–66) and 60 (SE 18, CI 25–96) months, respectively. The median survival has not yet been achieved (>6 years). There was no treatment-related mortality. The use of HDCT in patients with chemosensitive, de novo metastatic breast cancer is safe and well tolerated. Overall clinical outcome is good; however, this study cannot determine whether this was due to treatment or selection bias.