Aggressive chemosurgical debulking in patients with advanced ovarian cancer

From July 1986 to June 1989, 43 evaluable patients with advanced ovarian cancer were treated on protocol with initial cytoreductive surgery, two courses of high-intensity intravenous Cytoxan (1000 mg/m²) and cisplatin (120-200 mg/m²) chemotherapy, and repeat debulking laparotomy in an effort to maximize response to a subsequent four cycles of intraperitoneal platinum-based chemotherapy. Two patients were stage IIIA, 2 stage IIIB, 28 stage IIIC, and 11 stage IV. Five tumors were grade 1, 9 grade 2, and 29 grade 3. Thirty-eight (88%) patients had bulky tumor (5-25 cm) found at first laparotomy; 25 of these had >1-cm residual after initial debulking. Following two cycles of intensive intravenous chemotherapy 18 of these 25 had >1-cm disease found at second laparotomy; 12 of 18 underwent secondary cytoreduction to <1 cm. Thus, 30 of these 38 (79%) patients entered the intraperitoneal phase of the protocol with <1-cm disease. Four patients had 2- to 5-cm tumor at initial laparotomy; two of four were debulked to <1-cm residual. All four were found to have <1-cm disease at second laparotomy. This combination regimen was well tolerated. There was one treatment-related death. In sum, 42 of 43 patients had tumor >2 cm at staging laparotomy and 38 (88%) had large, bulky disease (5-25 cm); 34 of 43 (79%) entered the intraperitoneal phase of the protocol with optimal (<1-cm) disease. Aggressive chemosurgical cytoreduction in patients with bulky advanced ovarian cancer can leave a large proportion of patients with minimal residual disease and maximize their chances of responding to subsequent intraperitoneal chemotherapy.