Preoperative clinical and radiological features of metastatic ovarian tumors.

PURPOSE: To investigate the clinical characteristics and pre-operative imaging features of non-genital metastatic ovarian tumors. METHODS: A retrospective case series study that compared 18 patients with histologically confirmed non-genital metastatic ovarian tumors (the study group) with 25 patients who were diagnosed with a primary ovarian cancer (control group). RESULTS: The most common primary disease was breast cancer (n = 10; 55 %), followed by colon cancer, gastric cancer, lymphoma, and unknown primary malignancy. The diagnosis of the previous primary neoplasm preceded the ovarian tumor diagnosis by 1-20 years (mean 7 years). No differences were found in the presenting signs and symptoms between the two groups. Statistically significant differences were noted between the two groups in the composition of the adnexal mass on sonography (p < 0.0005) and the CA-125 levels (p = 0.007). The presence of a complex adnexal mass with papillary projections and CA-125 >170 U/ml predicted primary ovarian cancer in 95.7 % of patients. Pre-operative CT scan revealed a greater tendency toward omental involvement and ascites in the control group (p = 0.058). The median risk of malignancy index (RMI) 2 score was significantly higher in the control group compared to the study group (8,000 and 1,120 respectively, p = 0.001). Using a RMI 2 cut-off level of 3,800 for diagnosing primary ovarian cancer versus metastatic ovarian cancer, the sensitivity was 70 %, with a positive predictive value of 87.5 %. CONCLUSION: Pre-operative sonography findings, CA-125 levels and RMI 2 scores can be highly accurate in differentiating between primary and metastatic ovarian tumors.

Combined chemotherapy regimen of carboplatin and paclitaxel as adjuvant treatment for papillary serous and clear cell endometrial cancer.

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCCC) are highly aggressive variants of endometrial cancer. The optimal adjuvant regimen for these uterine malignant types has not yet been defined. The objective of this study was to evaluate the efficacy and toxicity of a combined chemotherapy regimen of carboplatin and paclitaxel as adjuvant treatment for patients with UPSC and UCCC variants. METHODS: A retrospective analysis of results of adjuvant chemotherapy that was based on 6 cycles of carboplatin (area under the curve, 5-6) and paclitaxel (175 mg/m2) q3 weeks. RESULTS: Twenty-one patients were eligible for analysis. All patients in this group underwent surgery before chemotherapy, with reported optimal debulking in 90% (n = 19). Fourteen patients (66%) had advanced stage (International Federation of Gynecology and Obstetrics stages III-IV) at the time of diagnosis. Five patients (24%) were treated with pelvic radiotherapy after the chemotherapy regimen. Clinical no-evidence-of-disease status was recorded in 19 patients (90%) at the end of the planned chemotherapy schedule. With a median follow-up of 25 months (8-61 months), 11 patients (58%) had recurrence and all have died of disease. Median progression-free interval was 13 months with a median survival of 27 months. Grade 3 toxicity was recorded in 7 patients (33%). Neutropenia developed in 3 patients (14%), neuropathy in 3 (14%), anaphylaxis in 1 (4.6%), and anemia in 1 (4.6%). Dose reduction was needed in 6 patients (29%), treatment delay in 6 (29%), and treatment cessation in 2 patients (10%). CONCLUSIONS: The regimen of carboplatin and paclitaxel is active in patients with UPSC and UCCC with an acceptable toxicity profile.

Analysis of two topotecan treatment schedules in patients with recurrent ovarian cancer.

Two topotecan treatment schedules in patients with recurrent epithelial ovarian cancer were evaluated. Protocol A (21 days) was 1.5 mg/m(2)/day topotecan on days 1 through 5 of a 21-day cycle; Protocol B (weekly) 4 mg/m(2) on days 1, 8, and 15 of a 28-day cycle. Efficacy was determined by clinical exam, CT scan, and CA125 levels. Forty-three patients on Protocol A and 21 on Protocol B were evaluated. As second-line treatment, Protocol A response was 9/20 (45%). Response to Protocol B was 4/17 (23.5%; NS). As third line or more, the response on Protocols A and B together was only 3/27 (11%). High-grade haematological toxicity was reported in 12/43 (27.9%) on Protocol A and 1/21 (4.8%) on Protocol B (p = 0.04). There was no difference in progression-free-intervals between schedules in second-line treatment. The weekly protocol had lower severe haematological toxicity. Clinical response in third line or more was very low.