Treatment of advanced ovarian cancer with cisplatin, adriamycin, and cyclophosphamide: effect of treatment and incidence of intracranial metastases.

A retrospective analysis of 42 patients with stage III, IV, or recurrent epithelial ovarian carcinoma treated with monthly cisplatin, Adriamycin, and cyclophosphamide (PAC) was made. Of 36 patients with measurable disease, 18 (50%) achieved a clinical complete response (CR) and 12 (33%) achieved a partial response (PR) for an objective response rate of 83%. Six stage III patients remained without measurable disease after surgery and postoperative PAC and are included in the survival data. The median survival of all patients was 22 months (10 months for nonresponders), with a median duration of response of 15 months (19+ months for clinical complete responders). Of 16 patients who underwent second-look laparotomy while in clinical CR, 8 were pathologically free of disease. Of these 8 surgically staged CRs, 2 have suffered CNS relapses, while the rest remain free of disease. One additional patient, who had been found to have only microscopic disease at the time of second-look surgery, subsequently relapsed in the CNS, for a total of 3 patients with CNS relapse. We conclude that PAC is an effective regimen, but that prolonged survival of these patients may put them at greater risk for CNS relapse.