The use of intravenous phenylalanine mustard followed by supervoltage irradiation in the treatment of carcinoma of the ovary.

Between 1970 and 1980, 50 patients with carcinoma of the ovary were treated sequentially with six courses of IV phenylalanine mustard (L-PAM), second look surgery, and radiotherapy using the strip technique. Seven patients had advanced Stage I disease and six patients had Stage II disease; all of these patients are alive and well with no evidence of disease (NED) with a mean survival of five years. Thirty-seven patients had Stage III disease: ten of these patients did not respond to L-PAM (26%); 17 patients had a partial response (48%), and four of these (22%) are alive with NED and a mean survival of five years; ten patients (26%) had a complete response to L-PAM and all are alive and well with a mean survival of five years. The presence of a minimal tumor burden after the initial surgery, a mixed histology, a low-grade differentiation, suppression of leukocyte count to below 2000/mm3 after the first course of chemotherapy, and a complete response to L-PAM, were all factors that contributed to the probability of a long-term survival. Tumors responding to L-PAM and then recurring also responded to a combination of cisplatin and adriamycin, and hexamethylmelamine.