Second-look procedures in ovarian cancer patients receiving six vs. nine courses of platinum, adriamycin, cytoxan (PAC) chemotherapy: the SCPMG experience 1982-1985.

From July 1, 1982, through December 31, 1985, 100 patients with Stage I, II, or III ovarian cancer, who were clinically NED following primary chemotherapy, underwent second look laparotomy. A prospective, nonrandomized study was set up among the various institutions within the Southern California Kaiser Permanente Medical Group. Those patients being treated at the Tertiary Oncology center received six courses of PAC while patients treated at other centers received nine courses of PAC. There was no selection as to severity of disease. Patients with Stage IV disease were not subjected to second-look procedures. Twenty patients with Stage I disease received other than PAC chemotherapy. Eighty patients with Stage II and III disease received PAC chemotherapy; 39 had six courses and 41, nine courses or more of PAC. Standard second-look procedure was performed and the status of the second-look procedure was the determining factor of response. Eighteen of the 39 patients (46%) who received six courses and 26 of 41 patients (63%) who received nine courses of chemotherapy had negative second-look procedures. Sixty-five patients had Stage III ovarian cancer, 34 with six courses of therapy and 31 with nine courses of therapy. There was no statistical difference in the incidence of positive or negative second-look procedures between the groups. The therapeutic index of six courses of PAC chemotherapy was in our hands, higher than with nine courses, since there was no observed difference in the status of the second-look and there was significantly more toxicity with the nine courses of therapy.