Search

Background: The impact of radical bowel resection with multiple organ resection on the survival if patients with advanced ovarian carcinoma has not been well defined. The authors investigated whether primary cytoreductive surgery including rectosigmoid colon resection would affect the recurrence free interval and survival of these patients., Methods: Between April 1990 and April 1997, 66 previously untreated Stage IIIC-IV ovarian carcinoma patients with macroscopic involvement of the rectosigmoid colon were enrolled. All patients underwent cytoreductive surgery with rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy., Results: The median follow-up was 26 months (range, 7-104 months). In multivariate analysis, residual disease and depth of tumor infiltration of the bowel wall were independently associated with overall survival and recurrence free interval. Disease stage was independently associated only with overall survival. Residual tumor was the most strongly predictive factor for recurrence or death. The 2-year estimated survival rates according to the amount of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. None of the 14 patients with residual disease larger than 1 cm were alive 2-years after operation. Overall, 48 patients (72.7%) developed disease recurrence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in the pelvis., Conclusions: The current findings suggest that cytoreductive surgery with rectosigmoid colon resection should be considered for ovarian carcinoma patients with bulky pelvic disease to help ensure that they are left with no residual disease after debulking surgery., (Copyright 2000 American Cancer Society.)

Background: The purpose of this study was to determine the role of neoadjuvant intraarterial chemotherapy (NIC) in patients with advanced cervical cancer., Methods: From June 1989 to December 1993, 36 consecutive patients with International Federation of Gynecology and Obstetrics Stage IIIB-IVA cervical cancer were admitted to the study. Treatment consisted of a bilateral infusion in the internal iliac artery of bleomycin (2.5 mg), doxorubicin (10 mg), and cisplatin (20 mg) for five courses after a 4-day rest period., Results: Twenty-nine (80.5%) patients received 100% of the programmed chemotherapeutic dose. The major toxic effects, according to World Health Organization criteria, were hematologic (19.4%, Grade 3 or 4), renal (2.8%, Grade 2), and gastrointestinal (61.1%, Grade 1 or 2). Only four patients (11.1%) had scanty bleeding around the site of catheter insertion. Neoadjuvant intraarterial chemotherapy induced responses in 33 of the 36 patients (5 complete, 28 partial; overall response rate, 91.7%), thus permitting radical surgery in all of these cases. Pretreatment characteristics were analyzed for response to NIC. None of the clinical parameters studied were related to chemoresponsiveness. A lower than expected incidence of lymph node metastases was detected (33.3%). Ten (30.3%) of the 33 patients who underwent surgery had disease recurrence. Lymph node status and pathologic parametrial involvement were significant prognostic factors for recurrence. The 5-year estimated survival for patients with a complete response, partial response, and stable disease was 100%, 36.2%, and 0%, respectively (P < 0.001). Clinical stage (P = 0.003) and response to NIC (P < 0.001) were significant prognostic factors in the overall estimated survival. The 5-year actuarial survival for patients with Stage IIIB and IVA disease was 66.7% and 0%, respectively., Conclusion: These results suggest that NIC should be considered as a means of achieving prompt local control before surgery and/or radiotherapy.