Recurrent ovarian cancer is still a significant problem despite intensive primary therapy, consisting of radical surgery and subsequent chemotherapy. The primary reason for consequent follow up investigations and immediate start of second-line therapy in cases of recurrence is based on the fact, that patients with relapse more than 12 months after primary therapy have a mean survival of 105 weeks after diagnosis. The value of surgical treatment is controversially discussed in the literature. Several authors argue, that there is no definitive prolongation of survival. Between January 1984 and July 1990, 285 patients presented themselves at our hospital with recurrence or progression of ovarian cancer. 72 of these patients had surgical treatment and those patients are part of the investigation. The mean survival of the patients (n = 18), which were operated with no remaining tumour, was 166 weeks. The average survival time of the 22 women with up to 2 cm remaining tumour was 108 weeks. The average survival time of the 32 patients with more than 2 cm after surgery was 72 weeks. One important criterion for the achievable tumour-free situation after surgery was the distinction between primary progression and relapse, where relapse was defined as recurrence more than 12 months after primary treatment. 29% of the patients with relapse could be operated tumour-free, a situation which could be achieved only in one of 13 patients (8%) with primary progression of the disease. Surgery in recurrent ovarian cancer is only indicated in patients with relapse more than 12 months after primary surgery. Tumour-free patients have significant benefit from the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Zusammenfassung: Condylomata acummete stellen angestchts der ansteigenden Prävalenz in der weib lichen Bevölkerung ein zunehmende s Problem für den behandelnden Gynäkologen dar. Rezidivraten bis zu 65 %lassen erkennen, daß das optimale Behandlungskonzept noch nicht gefu nden ist. In einer prospekt iv random isiert en Studie wurden insgesamt 24 Patientin nen mit Condyloma ta acuminata durch Laservaporisation therapiert und adjuvant entweder mit 1 MU ode r 3 MU /d ie Interferon «z a über S Tage mit anschließend 2 Wochen Pause über 3 Zyklen beha nde lt. Die Partner wurden in unserer urologischen Klinik abgeklärt und gegebenenfalls behandelt. Parallel zur Interferontherapie wurde eine durchttugzytornetrtsche Analyse der lymphozytensubpopulationen im Blut vorgenommen. 33,3 % Rezidiven in der 3-MU-Gruppe stehen 12,S%in der l-MU-Gruppe gege nüber. Der Unterschied ist statistisch nicht signifikant. 70,6%aller Partner zeigte n pen tskoplsch Zeichen einer HPV-Infektion. Die Vertei lungsmuste r der Lymphozytensubpopulatio nen unserer Patien tinnen waren im wesentlichen normal, verg lichen mit einer Kontrollgruppe. Die lnterleronbehandlung führte zu keinen nennenswerten Änderu ngen. ledi glich 2 Patientinnen mit Rez idiven hatten eine n erniedrigte n Anteil an aktivierten T-lymphozyten , der du rch Interlero nt herapie nicht gest eigert wurde. Die Studie zeigt die enorme Bedeutung von Part nerdiag nost ik und-t herapie bei der Behandlung von Condylomata acuminata. Zwischen den be iden Behandlungsa rmen best anden hinsichtlich de r Rezidivrate keine signifikanten Unter schiede. Die du rchflußzytometrischen Untersuchungen konnten keine Interferonwirkung nachweisen. Adjuvant Interferon and Lase r Vapourlsatlon In the Treatment of Condylomata ac u m lnata-5tralegles t o Prev ent Recurrence: 'rhe mcreastnq fncrdence of condylomat a acuminata in younger women resuns in growing prob lems for gynaecologists. Recurrence rares up to 65% demoostrate the need for improved t reatment concept s. In a prospecnve randorntsed study 24 temele patients wit h genital warts were treeted by laser vaporisation end 3 cydes 01 adjuvanl subcuta neous adrmn-Istrenen of eith er 1 MU or 3 MU Interferon (12 41 daily tor üve davs. followed by 2 weeks without medlcatlon. Their partners were referred to 41 urological HPV dmlc and treated. if necessary. During inter feron the rapy, sequential determinations of lymphocyte se bsets in th e periphera l blood were carrted out by flow cytometrical analysts. The follow-up period was 1 yea r. The recurrence rolle in th e 3 MU group was 33.3 %compared tc
Only 20-50% of patients with advanced ovarian cancer have minimal residual disease after aggressive primary cytoreductive surgery. For patients with residual tumour, responding to platinum-based chemotherapy, new therapeutic procedures should be attempted. In most cases, the benefit of performing secondary surgery could not be clearly demonstrated. But there is a consensus of opinion that a second-look procedure in order to confirm complete remission does not improve survival. Between January 1984 and July 1990, 346 patients with primary ovarian cancer were treated at our institution. 190 patients underwent secondary surgery, 93 of these had secondary debulking and are part of the study. After secondary cytoreductive surgery 38 patients (41%) had no residual disease, 35 patients (38%) had disease less than 2 cm, and 20 patients (21%) had disease greater than 2 cm. Mean survival in patients with no residual disease after secondary debulking surgery was 46 months and significantly longer as in patients with residual disease. Patients with residual tumour at primary surgery and no secondary cytoreductive operation survived 35 months, with a significant difference to the patients with secondary debulking and no residual disease. Secondary debulking surgery should be performed in all patients in whom minimal residual disease can be achieved. Preoperative diagnostic tools, including CA 125 value, computed tomography and immunoscintigraphy, should predict a tumour-free situation after secondary cytoreductive surgery.
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