VI Autologous Bone Marrow Transplantation.pdf - Blog Science ...

CONVENTIONAL TREATMENT RESULTS IN EPITHELIAL
OVARIAN CANCER
Ralph S. Freedman, M.D., Ph.D.
Presented at:
Sixth International Symposium on Autologous Bone Marrow Transplantation
Houston, Texas
December 3,1992
Professor of Gynecology
Department of Gynecologic Oncology
The University of Texas
M.D. Anderson Cancer Center
1515 Holcombe Boulevard, Box 67
Houston, TX 77030
(713) 792-2770
(713) 792-7586 (FAX)
CONVENTIONAL TREATMENT RESULTS IN EPITHELIAL OVARIAN CANCER
Ovarian cancer is the most frequent cause of death due to a gynecologic malignancy.
The overall survival of all patients with ovarian cancer is 38% (1>
. Approximately
80% of these patients present in stages III and IV. Moreover, only
20% of the patients who present in stages HI and IV survive five years with the
best currently available therapy.
Standard treatment of epithelial ovarian cancer (EOC), the most common
type of ovarian malignancy, includes surgical removal of the primary and metastatic
tumors, followed by chemotherapy. The separate roles of surgery in chemotherapy
are discussed below.
SURGERY
Abdominal surgery is performed initially to establish a histopathologic diagnosis
of ovarian cancer and to establish the stage (Table 1). At exploration the
feasibility of tumor reductive surgery is determined and what can reasonably be
accomplished without subjecting the patient to undue morbidity. Although
there are exceptions, typically the operation includes bilateral salpingooophorectomy
with or without a hysterectomy and a total or subtotal
omentectomy. In certain situations portions of the small or large intestine or of
other organ systems may be removed to accomplish an optimum tumor reduction.
The main objective of the operation is to be able to obtain residual tumor
masses in which the diameters of individual metastases are less than 2 cm. This
approach is adopted by surgical oncologists since a number of studies have
shown longer survival patterns amongst those patients whose tumor residual
has been optimally reduced
. If this objective cannot be reasonably accomplished
because of extensive tumor infiltration or plaque formation, or multiple
SIXTH INTERNATIONAL SYMPOSIUM ON AUTOLOGOUS BONE MARROW TRANSPLANTATION 183