Chemotherapy for ovarian cancer: current concepts.

Ovarian cancer is the most common gynecologic cancer and has the highest case-fatality rate of all gynecologic malignancies: over one-half of all women diagnosed with ovarian cancer die of their disease. Chemotherapy for epithelial ovarian carcinoma has evolved rapidly during the last 15 years. Demonstrations that combination chemotherapy was superior to single-agent therapy began to improve outcome among women with this disease. By 1990, the advent of the platinum compounds had improved response rate, and the new standard of care combined platinum with alkylating agents. Recently, more significant progress has been made with utilization of the taxanes, which demonstrate not only improved response rates, but significantly prolonged survival as well. The most current clinical trials have established that taxane/platinum combination chemotherapy should be the standard of care for epithelial ovarian cancer. Recent and ongoing studies also address such issues as relative efficacy of different doses of taxanes and platinum, length of infusion for the taxanes, and interchangeability of the platinum compounds. This broad overview of the development of current standards of treatment also will address unresolved issues in this field, including intraperitoneal administration of chemotherapy and dose intensification.

High-dose chemotherapy in ovarian carcinoma.

High-dose chemotherapy supported by bone marrow transplantation is being seriously investigated as a way to increase response and prolong survival in women with ovarian carcinoma. This report is a broad review of attempts over the past several years to demonstrate advantages of the high-dose approach. The existing data for dose escalation, short of doses requiring hematopoietic stem-cell transplant, demonstrate increased response rates, but no survival advantage. When even higher doses of chemotherapy are used in concert with autologous transplant to combat hematologic toxicities, even higher response rates have been reported. Despite this, all survival data from these later studies are limited. There is some hint of survival benefit in certain populations, such as those women with limited disease or perhaps in more advanced disease that has not been previously treated. All of the studies taken as a whole effectively demonstrate the need for randomized trials to address the issue of whether this approach provides any advantage over standard-dose chemotherapy. Future efforts at studying high-dose chemotherapy and autologous transplantation for ovarian carcinoma should be focused in this area; until results are available from such trials, high-dose chemotherapy with transplant will remain an experimental procedure.

Decreasing rates of hospitalization for varicella among young adults.

Hospitalizations for varicella-zoster virus infection (n = 13,018) among active-duty Navy and Marine Corps personnel were studied retrospectively for the years 1981-1994. A large increase in hospitalization rates occurred during the 1980s, peaking in 1987 with 2025 total hospitalizations and a crude rate of 258/100,000 persons. Since that time, hospitalization rates have decreased markedly, with only 473 hospitalizations in 1994 (rate, 74/100,000 persons). In unconditional logistic regression risk factor modeling for varicella hospitalization, personnel at highest risk of hospitalization had foreign homes of record, were most junior in rank, had < or = 2 years of military service, were Filipino or black, were male, and served in the Navy. Adjusted risk of hospitalization fell > 2-fold from 1987-1988 to 1993-1994. These finding may assist military public health officials in developing strategies to prevent varicella morbidity.