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Primary treatment of advanced ovarian adenocarcinoma, stages III and IV.

In an attempt to improve the response rate and hopefully the survival rate in women with advanced ovarian adenocarcinoma, three new modalities of therapy for ovarian adenocarcinoma were undertaken in 97 women. Sequential therapy consisted of surgery followed by chemotherapy, second-look laparotomy, and subsequent whole abdominal radiation. Eight women exhibiting a complete clinical response to chemotherapy were subjected to this treatment. However, only one woman (12%) is surviving without evidence of tumor recurrence. Concomitant therapy consisted of external radiation and single alkylating agent chemotherapy in 23 women. Again, the survival was poor: a 5-year survival of 8% without tumor recurrence. The third treatment modality consisted of a randomized study of 66 patients in whom single agent therapy with melphalan was compared with multiple agent therapy consisting of cyclophosphamide, dactinomycin, and 5-fluorouracil. In those women with stage III and IV serous adenocarcinoma of the ovary, a 63% response rate was obtained in patients receiving triple chemotherapy as compared to a 45% response rate in those receiving melphalan. Moreover, 40% of the group given triple chemotherapy exhibited a complete response as compared to only 18% in the group given melphalan.