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Das Ovarialkarzinom — Alte Probleme, neue Hoffnungen

  • A. Pfleiderer
Conference paper

Ovarian Carcinoma, Old problems, New hopes

Summary

Survey of actual developments in therapy of ovarian carcinoma presented and discussed in 15th UICC congress. Main topics of therapy of ovarian cancer are prognostic relevant factors, extension and radicality of operation and new developments in systemic therapy. Concerning prognostic relevant factors three systems have to be distinguished: factos for resectability of tumor, for response to chemotherapy and for survival. The size of postoperative tumor residual is considered to be the essential factor for survival. A multivariate analysis of data of the prospective GOCA multicenter study in ovarian cancer stage III reveals extension to diaphragma and to gastrocolic omentum as the most significant independent prognostic factors for resectability. Measurement of ploidy and length of S-phase give a hint for survival, analysis of growth factors and oncogenes indicate response to chemotherapy. Tumors of low malignant potenial are a special entity. The few malignant forms are detected by cytophotometry. Conservative treatment is recommended. Corresponding to macroscopic visible extension 773 cases of ovarian cancer are analyzed for result of further treatment. In case of free mobile tumors without visible metastases a fertility preserving operation can be discussed for younger patients. In case of locally invasive or adherent growth without visible metastases outside small pelvis, and in case of extension to upper abdomen without massive peritoneal carcinosis, radical operation, lym-phnodes included, is recommended, is possible in most cases and will increase survival rate. In case of a massive peritoneal carcinosis chemotherapy must be first choice of treatment. The preceding operation is important for diagnosis, for resection of tumor mass and improves survival rate within the first years. Concerning chemotherapy, reduction and therapy of side effects are actual problems. In the multicenter study of GOCA, carboplatin proves to be less toxic concerning nephro- and neurotoxicity, yet more aggressive for bone marrow than cisplatin. Early recurrences, however, seem to be more frequent. There are interesting developments in prophylaxis of emesis and neurotoxicity of cisplatin. Escalation of dosage of cytostatics, however, improves remission rate, not survival. Immunotherapy gives some hope, but no real new way.

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Copyright information

© Springer-Verlag, Berlin Heidelberg New York 1991

Authors and Affiliations

  • A. Pfleiderer
    • 1
  1. 1.Universitäts-FrauenklinikFreiburg/BrsgDeutschland

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