phosphorus-radioisotopes and Cystadenocarcinoma

The use of intraperitoneal radioisotopes in the management of women with ovarian cancer is controversial. We analyzed the experience with intraperitoneal chromic phosphate P 32 at our institution, from October 1979 to February 1983, in 22 patients with various stages and grades of ovarian malignancy. Survival in stage I is 87.5% and in stage II, 50%. Survival is 88.9% among patients with grade 1 tumors and 33.3% for those with grade 3 lesions. Morbidity related to chromic phosphate P 32 was minimal; small bowel obstruction occurred in only one patient who had also received external pelvic irradiation. Our results suggest that chromic phosphate P 32 is a safe, well tolerated, inexpensive, and effective adjuvant to surgery in the management of selected patients with ovarian malignancy.

Topics: Adenocarcinoma; Brachytherapy; Chromium; Chromium Compounds; Cystadenocarcinoma; Endometriosis; Female; Humans; Middle Aged; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes

Topics: Breast Feeding; Chromium; Chromium Compounds; Cystadenocarcinoma; Female; Humans; Infant, Newborn; Milk, Human; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Radiation Dosage

Topics: Adult; Breast Feeding; Chromium; Chromium Compounds; Cystadenocarcinoma; Female; Humans; Infant, Newborn; Injections, Intraperitoneal; Milk, Human; Ovarian Neoplasms; Phosphates; Phosphorus Radioisotopes; Pregnancy; Pregnancy Complications, Neoplastic

New biologic information has led to a therapeutic program in Stage III ovarian cancer that considers the whole peritoneal cavity the tumor-bearing region and that uses intraperitoneal administration of ovarian cancer antiserum, intraperitoneal P-32, delayed split abdominal irradiation, and chemotherapy. The survival for those patients completing irradiation was 85%. Forty-nine patients with advanced (Stage III, IV, or recurrent) ovarian cancer have been treated with combinations of the present agents. Twenty-two patients have received intraperitoneal ovarian cancer antiserum without significant toxicity. Extensive staging has been a requirement for initial evaluation and includes maximal surgical resection, omentectomy, TAH and BSO, nodal biopsies, and peritoneal cytology. Nineteen patients had 5-mm nodules or less residual disease and were treated with colloidal P-32, abdominal irradiation, and chemotherapy; five of these patients received intraperitoneal antiserum before cytotoxic therapy. The four-year cumulative survival is 84%, and the disease-free survival 43%. A randomized prospective study is now examining the value of antiserum therapy. New experimental data from our laboratory indicate 1) the value of 2/3 biomarkers (alpha globulin and free secretory protein) in following patients for remission of disease and 2) the probability of the development of more effective antiserum with high specific titer. Studies of the radiosensitivity of ovarian cancer indicate the tumor was not different from other solid tumors. Our studies indicate the role of radiation therapy as a cytoreductive agent should be integrated in multimodality therapy and that the immune system offers new possibilities in amplifying therapeutic results.

Topics: Alpha-Globulins; Antigens, Neoplasm; Antineoplastic Agents; Biopsy; Brachytherapy; Carcinoembryonic Antigen; Cystadenocarcinoma; Female; Humans; Hysterectomy; Immunization, Passive; Neoplasm Staging; Omentum; Ovarian Neoplasms; Phosphorus Radioisotopes; Radioisotope Teletherapy

Between January 1960 and September 1972, 104 patients with limited epithelial carcinoma of the ovary received intraperitoneal radiocolloid. Fifty-six of these patients also received external beam radiation therapy to the pelvis (pelvic RT). Five-year actuarial no-evidence-of-disease survival rates were 95% for stage Iai, 82% for Iaii, 73% for Ib, 67% for Ic, 67% for IIa, 67% for IIb without gross residual tumor (GRT), 25% for IIb with GRT, and 50% for III with minimal or no GRT. The addition of pelvic RT following radiocolloid could not be shown to affect survival of patients with Stage I and IIa tumors. Small bowel complications were related to the use of pelvic RT, however, occurring in 2.2% of patients treated with radiocolloid alone and 24% of patients treated with colloid and pelvic RT (p less than 0.005). In patients who underwent abdominal surgery following treatment of ovarian cancer, no excessive complication rate was observed. We conclude that for patients with stages Iaii through IIa, postoperative radiocolloid appears to provide the greatest chance of survival with the least chance of complication. For patients with Stage IIb and III lesions in whom there is minimal or no GRT, radiocolloid followed by pelvic RT produced survival rates comparable or superior to any other form of postoperative therapy.

Topics: Adult; Aged; Cystadenocarcinoma; Cystadenoma; Female; Gold Colloid, Radioactive; Humans; Intestine, Small; Middle Aged; Neoplasms, Multiple Primary; Ovarian Neoplasms; Peritoneal Cavity; Phosphorus Radioisotopes; Radiation Injuries; Radiotherapy, High-Energy