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High dose chemotherapy with autologous stem cell support in the treatment of patients with ovarian carcinoma
Author(s) -
Shinozuka Takao,
Miyamoto Tsuyoshi,
Muramatsu Toshinari,
Hirasawa Takeshi,
Murakami Masaru,
Makino Tsunehisa,
Tanaka Yutaka
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990401)85:7<1555::aid-cncr17>3.0.co;2-4
Subject(s) - medicine , carboplatin , regimen , debulking , chemotherapy , cyclophosphamide , cisplatin , gastroenterology , surgery , oncology , survival rate , ovarian carcinoma , urology , ovarian cancer , cancer
BACKGROUND In this study, the authors reviewed long term results and prognostic factors of high dose chemotherapy (HDC) with autologous stem cell support administered to 105 patients with epithelial ovarian carcinoma. METHODS Prior to HDC, platinum‐based chemotherapy was given to optimize (n = 94) and/or to mobilize peripheral blood stem cells (n = 33). After maximum debulking surgery, HDC with stem cell support was given; it consisted of cyclophosphamide, doxoribicin, and cisplatin (Regimen A, administered to 58 patients) or cyclophosphamide and carboplatin (Regimen B, administered to 47 patients). RESULTS Five‐year overall and disease free survival (OS, DFS) rates (%) according to stage were IC: 92.3, 92.3; II: 73.3, 73.3; III: 58.1, 35.7; IV: 33.7, 22.6; relapsed: 37.5, 31.0; OS, DFS at 8 years were IC: 92.3, 92.3; II: 73.3, 73.3; III: 48.8, 31.7; IV: 33.7, 22.6; relapsed: 37.5, 31.0. There was no difference in survival between patients who received Regimens A and B despite an increase in the total dose of platinum and an increase of more than 1.5‐ to 3.5‐fold in the platinum course of HDC in Regimen B from the equivalence ratio of 4:1 between carboplatin and cisplatin. Among 65 Stage III and IV patients, the best results were obtained for 35 patients with small volume disease: 5‐year OS, DFS rates were 74.3, 51.6, and 8‐year OS, DFS rates were 66.4, 46.3. CONCLUSIONS Good long term results were obtained with HDC. Small volume residual disease, platinum sensitivity, and histology excluding mucinous and clear cell adenocarcinoma were important factors for better survival. However, because the results were obtained for selected patients, a prospective, randomized study comparing HDC and standard chemotherapy is necessary if any definitive conclusions are to be drawn. Cancer 1999;85:1555–64. © 1999 American Cancer Society.