Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials (original) (raw)
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Indonesian Journal of Obstetrics and Gynecology, 2016
Objective: To observe the success of platinum, vincristin, bleomycin and mitomycin C (PVB-MMc) combination chemotherapy on cervical carcinoma by evaluating apoptosis feature. Methods: This study was performed at Dr. Wahidin Sudirohusodo Hospital and several other hospitals. The method of this study was prospective longitudinal. Cervical biopsy was performed on 15 cervical carcinoma patients before and after PVB-MMc chemotherapy. Six patients were at early stage and 9 patients were at advanced stage. Biopsy result were sent to pathologic anatomic laboratory to be made into paraffin block and further examined for apoptosis with Tunel method. Data were analyzed by using Wilcoxon Signed Rank test. Results: Study results indicating no significant difference for apoptosis index before and after PVB-MMc chemotherapy for early stage (p=0.463), advance stage (p=0.594), but quantitatively there were increasing apoptosis index before and after chemotherapy. Conclusion: Chemotherapy combination...
Assessment of bleomycin, adriamycin and mitomycin-C in the treatment of recurrent cervical cancer
BJOG: An International Journal of Obstetrics and Gynaecology, 1985
Twenty women with recurrent squamous cell carcinoma of the cervix were treated with bleomycin followed by adriamycin and mitomycin-C. Treatment was repeated every 28 days. In 18 patients who could be assessed there was one complete response and five partial responses (response rate 33%). Two partial responses were seen in 13 lesions arising from previously irradiated sites of disease (response rate 23%). Three complete responses and three partial responses were observed in 10 lesions arising from non-previously irradiated sites of disease (response rate 60%). In all responding cases tumour regression was noted before the end of the third cycle of treatment. Toxicity was predictable and manageable. These results suggest that chemotherapy may be used as a cytoreductive procedure before radical local treatment.
Gynecologic Oncology, 1989
Twenty-three patients with gynecologic squamous cell carcinomas (20 cervical, 2 vulvar, 1 ovarian) were treated with bleomycin, vincristine, mitomycin-C, and &platinum. Twenty-one patients had prior radiation therapy. Of the 21 evaluable patients, the response rate was 48% with a median duration of 4 months. Toxicity in the 23 patients was high, with the most significant being that of pulmonary toxicity. Eight patients had pulmonary toxicity with 5 of 8 dying a respiratory death while free of disease. Bleomycin is excreted primarily by the kidneys, and its half-life is known to increase in patients with renal insufficiency. Patients with advanced, recurrent cervical cancer who have failed radiation therapy often have underlying renal compromise. Extreme caution should be exercised when administerhrg bleomycin with nephrotoxic chemotherapeutic agents in this Setting. 0 1989 Academic RUSS, I~C.
Gynecologic Oncology, 1983
Thirty-five patients with advanced cervical cancer were treated with a combination chemotherapy regimen comprising cisplatin, vinblastine, and bleomycin (PVB). Sixty-six percent of 33 evaluable patients showed objective tumor response and complete remissions were seen in six (18%) patients. The median duration of tumor response in patients with recurrent cervical cancer was 24 weeks (range 8 to 104 weeks). Multivariate analysis of pretreatment variables including prior radiotherapy did not identify patients with a higher response probability. Nausea and vomiting were usual side effects of chemotherapy and there was one definite treatment-related death. Cervical cancer is responsive to cisplatinbased combination chemotherapy. The role of chemotherapy in conjunction with radiotherapy or surgery in the treatment of locally advanced cervical cancer remains to be defined.
Single Agent Versus Combination Chemotherapy in Recurrent Cervical Cancer
Journal of Obstetrics and Gynaecology Research, 1998
Objective:Cisplatin and ifosfamide are two most active agents in patients with recurrent and metastatic cervical cancer. Combination of bleomycin, ifosfamide and cisplatinum (BIP) was compared with cisplatinum alone.Patients and Methods: One hundred and six patients with recurrent/persistent and metastatic cervical cancer received either a combination of bleomycin, ifosfamide and cisplatinum, (Group A, n = 50) or cisplatinum alone (Group B, n = 56) every 3 weeks for up to 6 courses. Ninety-seven patients were evaluable and were analysed for response and survival.Results:Patients receiving BIP (Group A) had a higher response rate (complete and partial responses), 52.2% vs 29.4%, p < 0.01 with overall median survival, 8 months (1 to 92+ months) vs 6 months (1 to 40+ months), p = 0.18. Chemotherapy responders had a significantly higher survival in both groups compared to the non-responders (Group A: 17 vs 6 months, p< 0.001, Group B: 20.5 months vs 5 months, p < 0.001). Patients in good performance status (ECOG, 0—2) had a significantly higher response rate to chemotherapy (Group A: 70.3% vs 26.3%, p < 0.01, Group B: 38.2% vs 11.7%, p < 0.05). In Group A, patients with extrapelvic disease responded better compared to pelvic disease (83.3% vs 34.5%, p < 0.01).Chemotherapy side effects were mainly nausea/vomiting, alopecia, myelosuppres-sion, reversible encephalopathy (in Group A), and impaired renal functions. Chemotherapy toxicity was higher for patients receiving BIP, 2 patients died of BIP toxic-ity. Currently, in ‘Group A’ 8 patients are alive, 7 disease-free and one with disease at a median interval of 51 months after chemotherapy treatment. While in Group B, 3 patients are alive, 2 disease-free and one with disease.Conclusions:Bleomycin, ifosfamide and cisplatin improved the response rate in recurrent and metastatic cervical cancer compared with cisplatinum alone. However, the toxicity was moderate and survival was not significantly improved. These results need to be confirmed in a phase III, randomized study in larger number of patients.
Gynecologic Oncology, 2005
Data about the outcome and prognostic factors in the group of patients with non-squamous cell advanced or recurrent carcinomas of the uterine cervix are limited. We compared the outcome of patients with non-squamous with that of squamous cell carcinomas after platinum-based combination chemotherapy as first line therapy for stage IV or recurrent cervical carcinoma. A total of 200 patients with stage IV or recurrent carcinomas of the cervix received platinum-based combination chemotherapy and were included in our analysis. There were 58 patients with non-squamous and 142 patients with squamous cell carcinomas. Response to chemotherapy was 53.5% in non-squamous vs. 43.5% in squamous carcinomas. Histology was not an independent predictor of tumor response (P = 0.797). Response rates were lower in patients with relapse only in a previously irradiated area in both squamous (26.9% vs. 53.5%, P = 0.005) and non-squamous carcinomas (47.1% vs. 65%, P = 0.270). Weight loss was the only significant predictor of survival in non-squamous histology patients (P &amp;amp;amp;lt; 0.0001). There was no significant difference in median survival between squamous (11.57 months [95% CI 9.35-13.79]) and non-squamous carcinomas (19.05 months [95% CI 13.63-24.47]) (P = 0.064). After adjustment for independent prognostic factors (ECOG performance status and weight loss), differences in survival remained not significant. Our study showed a similar outcome for both squamous and non-squamous stage IV or recurrent cervical carcinomas treated with platinum-based combination chemotherapy.
Induction chemotherapy followed by radical surgery in cervical cancer
Gynecologic Oncology, 1991
To evaluate the therapeutic potential of cytotoxic therapy in patients with squamous cell carcinoma of the cervix, 28 patients with disease clinically localized to the pelvis were treated with chemotherapy followed by radical pelvic surgery. Treatment consisted of c&platinum 50 mg/m', mitomycin C 10 mg/m', vincristine 1.0 mg/m', and bleomycin 10 U IM given as a course (over 21 days) of induction chemotherapy followed by radical hysterectomy and pelvic and aortic lymphadenectomy in 26 patients and total pelvic exenteration in 2 patients. The stage distribution of the patients in the study was 4 stage IB, 6 stage IIA, 7 stage IIB, 1 stage IIIA, 11 stage IIIB, and 1 stage IVA. Two patients with stage IIIB cancer were found, at the time of laparotomy, to have carcinomatosis and were excluded from the final evaluation in this study. All patients achieved a clinical and histologic response to chemotherapy. There were 35% complete and 65% partial responses. After chemotherapy, at the time of surgery, 4 patients were found to be histologically free of disease, and the incidence of surgically documented nodal disease after chemotherapy was found to be 32%. There was no significant hematologic or pulmonary toxicity. Induction chemotherapy is well tolerated and may be beneficial in the management of some patients with cervical cancer who are at high risk for failure with conventional treatment.
Chemotherapy for recurrent cervical cancer
Cancer Treatment Reviews, 2008
Cervical cancer is the second most common cancer of women worldwide and one of the leading cause of death in relative young women. This review gives an outline of chemotherapy of advanced, persistent or recurrent cervical cancer. We performed a literature search in the PubMed of almost all relevant articles concerning chemotherapy of advanced, persistent or recurrent cervical cancer. The available data from the literature is mainly composed of most recent reviews, phase II and randomized phase III clinical trials. Single-agent cisplatin remains the current standard therapy for advanced, persistent or recurrent cervical cancer. Several single-agents have been tested, but none has been found to be superior compared to cisplatin. Both topotecan and paclitaxel in combination with cisplatin, have yielded superior response rates and progression-free survival without diminishing patient quality of life. However, only the combination of cisplatin and topotecan has improved overall survival. It is important to identify clinical and tumor-related factors predictive of response to cisplatin-based chemotherapy. Future trials are necessary, not only to compare combinations of existing agents, but to incorporate biological agents (monoclonal antibodies or small molecules) to chemotherapy in order to improve the treatment results of advanced, persistent or recurrent cervix cancer.