Journal of Clinical Oncology, Vol 15, 1302-1308, Copyright © 1997 by American Society of Clinical Oncology
High-dose chemotherapy with hematopoietic rescue in patients with stage III to IV ovarian cancer: long-term results
M Legros, J Dauplat, J Fleury, H Cure, F Suzanne, J Chassagne, JO Bay, C Sol, M Canis, P Condat, B Choufi, F Tavernier, C Glenat, P Chollet and R Plagne
Centre Jean Perrin, Clermont-Ferrand, France.
PURPOSE: A series of 53 patients with poor-prognosis epithelial ovarian
cancer treated with high-dose chemotherapy (HDC) followed by hematopoietic
rescue was retrospectively studied from the day of diagnosis for toxicity
and long-term survival analysis. PATIENTS AND METHODS: Patients were
treated with surgery followed by cisplatin combination chemotherapy. After
second-look operation (SLO), HDC was administered: 23 patients received
melphalan (140 mg/m2 on day 1) and 30 patients received a combination of
carboplatin (400 mg/m2 on days 1 to 4) and cyclophosphamide (1.6 g/m2 on
days 1 to 4). After HDC, autologous stem-cell transplantation was performed
for hematologic support. RESULTS: One patient died of cardiac failure after
HDC, but the acute toxicity was acceptable for the other patients. With a
median follow-up of 81.5 months, the 5-year overall survival rate for the
53 patients was 59.9% and the disease-free survival (DFS) rate at 5 years
was 23.6%. Twenty-four patients (45.3%) were alive, 12 with no evidence of
disease and 12 with recurrent disease. The best results were achieved in 19
patients with pathologic complete response at SLO (74.2% 5-year overall
survival; 32.8% 5-year DFS). CONCLUSION: HDC followed by autologous
stem-cell support is a well-tolerated therapeutic approach for patients
with poor-prognosis ovarian carcinoma. In this report, the 59.9% survival
of 53 patients at 5 years must be compared to the 20% to 30% 5-year
survival observed after conventional therapy. These results should be
confirmed by an ongoing prospective randomized trial.
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