Adjuvant therapy for early-stage ovarian cancer

Article Abstract:

Of all the gynecologic cancers, ovarian cancer is the most difficult to treat and has the lowest survival rate. Epithelial ovarian cancer is the type that accounts for 90 percent of cancerous ovarian tumors, and survival is poor because in most women there are no symptoms until it has spread to regions beyond the pelvis. The main method for early detection is the physical examination, which may identify a pelvic mass. All cancerous masses should be thoroughly evaluated by comprehensive staging to determine how advanced the cancer is and how far it has spread. Comprehensive staging includes inspecting and palpating the entire abdomen, taking multiple biopsies from various organs and tissues, and even analyzing the fluid in the region. The failure to complete these procedures may have led to misclassification of the stage of cancer in women previously studied. Patients with more advanced cancer may have been wrongly diagnosed as having stage I or II cancer, and thus the survival rate for these early stages may have been estimated as lower than it really is. In the April 12, 1990 issue of The New England Journal of Medicine, Young et al. report that women with stage I ovarian cancer had an excellent five-year survival rate of over 90 percent. Those patients who had only surgical removal of the tumor were compared with others who also received chemotherapy; the chemotherapy with melphalan did not improve survival. Since melphalan can cause leukemia, and it was not beneficial, it appears that women with carefully diagnosed stage I disease can be treated with surgery alone. In another trial, patients with stage I or II ovarian cancer were given either melphalan or infusion of radioactive phosphate into the abdomen, in addition to surgery; both groups had the same disease-free survival rate at five years, 80 percent. Since no control group was included that had only surgery, it was not possible to determine whether both therapies were beneficial, or perhaps neither offered any advantage over surgery alone. Research continues into improved methods of screening for early diagnosis of ovarian cancer and also treatment with various combinations of chemotherapeutic agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Melphalan, editorial

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Adjuvant therapy in stage I and stage II epithelial ovarian cancer

Article Abstract:

Epithelial ovarian cancer is diagnosed in about 20,000 women each year in the United States, and of these cases, one third are classified as either stage I or stage II, considered localized cancers. Even though localized disease is more easily treated than cancer that has spread throughout the body, as many as half of these tumors return after they have been removed surgically. It is not known whether adjuvant treatment, which refers to any therapy in addition to the initial surgery, helps improve the chances of survival. Two national studies were performed to compare different modes of treatment for women with stage I or stage II epithelial ovarian cancer; comprehensive staging was performed to be certain of the stage of cancer in each patient. All subjects in both trials had initial surgery to remove the tumor, and then underwent various treatments. The first study included 81 women with stage I disease; they either received chemotherapy with the drug melphalan or no chemotherapy. The five-year disease-free survival rate was 91 percent for no chemotherapy versus 98 percent with melphalan, and overall survival by the time of follow-up (after an average of over six years) was 94 and 98 percent, respectively. These percentages were not significantly different, so neither treatment was preferable to the other. It should be noted that melphalan has some potentially serious side effects. The second study included 141 women with stage I or stage II cancer (stage II being limited to the pelvis); they received either melphalan or one treatment with radioactive chromic phosphate infused into the abdomen during surgery. Again the two treatments resulted in equivalent survival rates after five and six years; survival in both groups at both times was approximately 80 percent. It is concluded that comprehensive staging is important for determining which mode of treatment should be used for each patient. If the decision to forego or use adjuvant therapy is made wisely, both groups of patients can expect excellent long-term survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer

Article Abstract:

There is a great deal of evidence that mastectomy followed by chemotherapy and endocrine therapy prolongs disease-free survival and life expectancy in patients with operable breast cancer. This has proved to be the case in patients whose breast cancer had spread into the nearby lymph nodes. The more favorable prognosis of node-negative breast cancer has made clinicians reluctant to put patients through the rigors and the expense of chemotherapy. A study was conducted to evaluate the effectiveness of administering a single cycle of combination chemotherapy, including cyclophosphamide, methotrexate, fluorouracil, and leucovorin, to patients with operable node-negative breast cancer shortly after surgery. The average four year disease-free survival rate for patients who received chemotherapy was 77 percent, compared to 73 percent for similar patients who did not receive additional therapy. The need to develop a means of selecting patients who do not require adjuvant chemotherapy is indicated by the data. However, the four-year failure incidence of 23 percent, despite chemotherapy, emphasizes the need to better select and more effectively treat this group of patients. With the increase in breast cancer screening the numbers of women being diagnosed with operable node-negative breast cancer is increasing. Further clinical trials are recommended.

Breast cancer

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