Primary Peritoneal Carcinoma Patients Research Articles

A randomized phase 3 trial of intraperitoneal versus intravenous carboplatin with dose-dense weekly paclitaxel in patients with ovarian, fallopian tube, or primary peritoneal carcinoma (a GOTIC-001/JGOG-3019/GCIG, iPocc Trial) (LBA 3)

<b>Objectives:</b> Traditionally, the target of intraperitoneal (IP) chemotherapy for ovarian cancer was patients with minimal residual disease after debulking surgery. However, our pharmacological study suggested that IP carboplatin therapy should also be feasible for patients with larger size residual disease, and our previous phase 2 study demonstrated a satisfactory response rate of IP carboplatin plus dose-dense paclitaxel (ddTCip) regimen in patients with macroscopic residual disease after initial surgery for ovarian (OV), fallopian tube (FT), and primary peritoneal (PP) carcinoma. The purpose of this study is to assess whether IP administration of carboplatin is superior to intravenous (IV) administration of carboplatin (ddTCiv regimen) in OV, FT, and PP carcinoma patients with either minimal or macroscopic residual disease. <b>Methods:</b> Eligible patients were those with newly diagnosed stages II-IV disease. All patients were to undergo an initial laparotomy or laparoscopy with primary debulking surgery if possible. Before abdomen was closed, patients were randomized to either IV or IP arm. An IP port and catheter was placed if the patient was assigned to IP arm. Chemotherapy regimen was either IV paclitaxel plus IV carboplatin (IV arm) or IV paclitaxel plus IP carboplatin (IP arm). Dose of paclitaxel was 80 mg/m² Q1W and dose of carboplatin was at an area under the curve (AUC) of 6 Q3W. Each patient was to receive 6 to 8 cycles of chemotherapy. Patients with bulky residual disease were allowed to undergo interval debulking surgery followed by assigned arm regimen up to 8 cycles total. Primary endpoint was PFS, and secondary endpoints included OS, safety, QOL, and cost/benefit. <b>Results:</b> Total of 655 patients were randomized between 2010 and 2016 from Japan, Singapore, Korea, New Zealand, USA, and Hong Kong. Stage distribution was II (n= 88), III (n=448), and IV (n=119). Size of residual disease at randomization was either 0 cm (n=163), < 1 cm (n=97), 1-2 cm (n=33), or >2 cm (n=362). Histological types were serous (n=420), endometrioid (n=61), clear cell (n=74), and others (n=100). Median follow-up was 55.7 months. IP chemotherapy significantly improved PFS in the ITT population (HR=0.83, 95%CI:0.69-0.99, p=.041) and in the 602 eligible patients (HR=0.78, 95%CI:0.65-0.94, p=.009). Median PFS for ITT population was 20.7 (95%CI: 18.1-22.8) months in the IV arm and 23.5 (95%CI: 20.5-26.9) months in the IP arm. Median PFS for eligible patients was 20.0 (95%CI: 18.0-22.2) months in the IV arm and 22.9 (95%CI:19.6-26.9) months in the IP arm. Subset analysis showed that the survival benefit was greater in patients with larger size residual disease. Toxicity profile was essentially equivalent in both arms except for catheter-related toxicities (11.8%). <b>Conclusions:</b> ddTCip chemotherapy improved the PFS over ddTCiv regimen in patients with OV, FT, and PP carcinoma regardless of the residual tumor size after initial surgery.

Primary peritoneal carcinoma and ovarian carcinoma - a ten-year comparative analysis.

Primary peritoneal carcinoma (PPC) at presentation often masquerades as epithelial ovarian carcinoma (OC) but behaves different with respect to treatment response, recurrence patterns and has inferior outcomes. The objective of this study is to compare the clinicopathological features and survival outcomes of PPC and OC. Prospectively maintained database of patients presenting to the gynecologic oncology department at a tertiary hospital was reviewed between 1st January 2010 and 31st December 2020. A comparative analysis of high-grade serous stage III/IV PPC and OC was done. Demographics, treatment details, complications and survival outcomes were collected from electronic medical records. 151 OC and 69 PPC patients were included. A higher proportion of women with PPC had reduced performance status prior to hysterectomy with salpingo-oophorectomy, a shorter symptom to treatment interval, and large volume ascites. A significantly lower number of women with PPC (4.3 vs. 46.1%; P &lt; 0.001) underwent primary cytoreduction, had a lower median surgical complexity score (3 vs. 4; P &lt; 0.001) but higher recurrence rates (66.7 vs. 47.0%; P = 0.041) as compared to the patients with OC. The median progression-free survival (PFS) was 18 (15-20) months in PPC and 23 (17-28) months in OC patients (log-rank P = 0.034), while the median overall survival (OS) was similar (44 vs. 48 months; log-rank P = 0.696). The presence of extraperitoneal disease and interval cytoreduction was associated with shorter PFS. Suboptimal cytoreduction and delay in adjuvant chemotherapy beyond 6 weeks post-surgery was associated with reduced OS. PPC is an aggressive disease with lower PFS compared to OC. Commonly presenting with large volume carcinomatosis, it is not amenable for primary cytoreduction, making the usage of neoadjuvant chemotherapy a common practice and pragmatic approach.

Serum HE4 is associated with clinical prognostic factors and survival outcome in female patients with primary peritoneal carcinoma.

The aim of this study was to investigate whether serum HE4 was associated with clinical risk prognostic factors and survival outcome. In this study, 72 patients with primary peritoneal carcinoma (PPC) from January 2011 to October 2019 participated. Serum HE4 and CA125 levels were detected at primary diagnosis, post-surgery, pre-recurrence and the presence of recurrence. The relations between serum HE4 levels with clinical prognostic factors were analyzed, and the hazard ratios between serum HE4 levels with overall survival and recurrence-free survival were also analyzed by univariate and multivariate survival analysis. HE4 and CA125 levels were significantly elevated in serous type, high histological grade, advanced stage and positive lymph node status and residual tumor diameter more than 1cm, respectively, compared with those in non-serous type, low histological grade, early stage, negative lymph node status and residual tumor diameter no more than 1cm, respectively. HE4 was an independent prognostic factor for recurrence-free survival and overall survival with hazard ratios of 5.36 (95% confidence interval: 2.19-13.15) and 4.48 (95% confidence interval: 1.87-10.74), respectively. HE4 is correlated with clinical risk prognostic factors in PPC and is effective in the recurrence detection and predicting outcome in PPC patients.

Diagnostic and prognostic value of HE4 in female patients with primary peritoneal carcinoma.

HE4 is a useful tumor marker for the diagnosis of ovarian, endometrial, and fallopian tube carcinoma. The aim of our study was to investigate the value of serum HE4 compared with CA125 in the diagnosis of primary peritoneal carcinoma and the estimation of treatment response and recurrence. Serum HE4 and CA125 concentrations were measured in both primary peritoneal carcinoma patients and benign gynecological disease controls. The treatment response and recurrence were assessed by serum HE4 and CA125 levels in primary peritoneal carcinoma patients. Serum HE4 and CA125 levels were significantly increased in primary peritoneal carcinoma patients compared with benign disease controls ( P<0.001). Compared with CA125, HE4 had lower sensitivity (84.2% vs. 94.7%), but higher specificity (99.2% vs. 85.3%); the combination of HE4 and CA125 led to higher sensitivity and specificity. In the receiver operating characteristic analysis, the area under the curve was 0.956 for HE4, for CA125 was 0.953, for HE4+CA125 was 0.979. Furthermore, HE4 and CA125 were closely associated with treatment response, and our results indicated that primary peritoneal carcinoma patients displayed a larger drop of HE4 compared with CA125 (75.8% vs. 61.5%). Combined with CA125, HE4 elevation better predicted recurrence in primary peritoneal carcinoma patients during the remission period after treatment. This study indicated that the detection of serum HE4 changes may enhance the effectiveness for detecting primary peritoneal carcinoma and estimating the outcome of treatment and recurrence in female primary peritoneal carcinoma patients.

Outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of primary peritoneal carcinoma

Primary peritoneal carcinoma (PPC) is rare tumor, traditionally treated with surgical debulking and systemic chemotherapy (SC) with 30% five-year survival rate. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) may improve long-term survival. Thirty patients with PPC were identified. Twenty-three patients underwent CRS/HIPEC as initial treatment (group I) and 7 for recurrent disease (group II). Peritoneal cancer index (PCI), cytoreduction scores (CC), overall survival (OS) and progressionfree survival (PFS) were estimated using Kaplan-Meier survival analysis. FIGO stages II/III/IV at diagnosis were 2/20/7 (1 was not classified). Median time from diagnosis to CRS/HIPEC was 2 months and 8 months in groups I and II, respectively. PCI≥20 was seen in 16 (70%) and 4 (57%) in groups I and II, respectively. Complete cytoreduction (CC 0-1) was achieved in 30/32 (94%) CRS/HIPEC procedures. Median follow-up was 39 months (range: 11-250). PFS at 1, 3, 5-years was 80%, 75%, 59%, respectively. OS 1, 3, 5- years from CRS/HIPEC was 90%, 68%, 55%. CRS/HIPEC and adjuvant SC provides five-year survival rate higher than previously reported for PPC patients who received conventional therapy with surgical debulking and SC.

Brain metastasis from primary peritoneal carcinoma: Case report and literature review

Here, we describe a patient with primary peritoneal carcinoma (PPC) who developed a late, solitary brain metastasis. It is a case of a 68-year-old female presented with a 1-month history of progressive gait disturbance who had undergone a surgical resection of PPC five years prior, followed by adjuvant chemotherapy. An MRI revealed a 4.6cm mass lesion in her right cerebellum. The patient underwent total removal of the tumour. The histopathology was consistent with a brain metastasis due to PPC. This condition is a rare malignancy of peritoneum, and only six cases of brain metastasis have been reported in PPC patients to date. Due to the prolongation of survival resulting from advanced chemotherapy for PPC, more patients will live long enough to develop brain metastases.

The utilization of positron emission tomography (PET) scans in ovarian, fallopian tube, and primary peritoneal carcinoma patients may be associated with improved overall survival

The utilization of positron emission tomography (PET) scans in ovarian, fallopian tube, and primary peritoneal carcinoma patients may be associated with improved overall survival

Stage IIIC ovarian/peritoneal serous carcinoma: a heterogeneous group of patients with different prognoses.

Primary ovarian serous carcinoma patients presenting with regional lymph node metastasis without extrapelvic peritoneal metastasis are considered International Federation of Gynecology and Obstetrics (FIGO) Stage IIIC. We studied their controversial survival compared with patients with extrapelvic peritoneal metastasis in same Stage IIIC. We included primary peritoneal carcinoma patients with lymph node metastasis to investigate whether primary site of tumor has a prognostic role. Charts of patients treated at the MD Anderson Cancer Center in Houston, TX; from 1992 to 2010 were reviewed. Primary ovarian serous carcinoma patients were grouped into patients with lymph node metastasis without extrapelvic involvement (Group 1, n=13) and patients with additional extrapelvic peritoneal involvement (Group 2, n=43). Group 3 patients (n=38) were selected using similar criteria as Group 2 but with negative lymph nodes. Group 4 patients were those with primary peritoneal serous carcinoma with lymph node metastasis (n=13). Group 1 patients had statistically significant better overall survival compared with the rest of the groups. Overall survival was significantly better in Groups 4 versus 2 and Groups 3 versus 2. Primary ovarian serous carcinoma patients with lymph node metastasis without extrapelvic peritoneal involvement have better survival than those with additional extrapelvic peritoneal involvement. Primary peritoneal serous carcinoma patients with lymph node metastasis have better survival than those with primary ovarian serous carcinoma with peritoneal and lymph node metastasis. Ovarian serous carcinoma patients with extrapelvic peritoneal involvement alone have better survival than those with extrapelvic peritoneal involvement and lymph node metastasis. These findings support the proposition to revise the FIGO staging system, especially for Stage IIIC patients, in order to reflect these prognostic differences.

Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease: An analysis of Gynecologic Oncology Group (GOG) 182

PurposeTo examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival. Patients and methodsWe reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease <1cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan–Meier and proportional hazards methods. ResultsFour-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2months (mos) and 14.8mos (p<0.01) and OS was 49.8mos v. 43.7mos (p=0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR=1.03, 95% CI 0.91–1.15; OS HR=0.92, 95%CI 0.81–1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4mos (p=0.0005). ConclusionsUAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.

Elderly patients and ovarian epithelial cancer (OEC) or primary peritoneal carcinoma (PPC): A retrospective analysis.

e20718 Background: OEC frequency in elderly patients is increasing around the world and it’s expected to continue rising in the future. PPC is an entity with a similar behaviour. OEC is the most common cause of gynaecologic cancer-related death and it’s the fifth leading cause of cancer associated mortality among women; its relative risk is higher among elderly patients. In this study we try to identify clinical factors in elderly OEC and PPC patients in order to improve current medical management and to enhance clinical outcomes. Methods: From January 2007 to December 2011 a total of 53 elderly patients were included (≥65 years old). PPC: 11.3%; OEC: 88.7%. ECOG 0/1/2/3/4: 24.5/34/26.4/7.5/5.7%; 1.9% unknown. Stage at diagnosis: III (52.8%); IV (30.2%). Ca125 was increased in 79.2% of the cases; 64.2% of the patients underwent debulking surgery. The majority of patients (94.4%) received chemotherapy: monotherapy (13.2%) or polychemotherapy (86.8%). Results: Among 38 evaluable patients, partial response was observed in 45.4%, complete response in 27.2%, stable disease in 24.4% and progression in 3%; 18% of patients were retreated with the same schedule (platinum sensitivity) and 26.4% of the patients received more than one line of chemotherapy (range 2-5). Significant differences in overall survival (OS) were observed in multivariate analysis according to performance status (p=0.018). Median OS for all patients was 131 weeks. Conclusions: In our experience, results in elderly patients are comparable to those expected in younger patients. In this population, treatment options must be optimized.

Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease: An analysis of GOG 182

Upper abdominal procedures in advanced stage ovarian or primary peritoneal carcinoma patients with minimal or no gross residual disease: An analysis of GOG 182

Platinum resistance and impaired survival in patients with advanced primary peritoneal carcinoma: matched-case comparison with patients with epithelial ovarian carcinoma

The objective of the study was to compare chemotherapy response and survival of patients with advanced primary peritoneal carcinoma (PPC) vs those with epithelial ovarian carcinoma (EOC). From 1998 to 2004, 43 PPC patients were identified and matched to 129 patients with International Federation of Gynecology and Obstetrics stage IIIC-IV EOC by criteria abstracted from medical records. Primary endpoints were chemotherapy response, platinum resistance, progression-free survival (PFS), and overall survival (OS). All patients received primary platinum-taxane chemotherapy. There was no significant difference in achieving a clinical complete response. PPC patients were more likely to be platinum resistant at 6 months and had significantly impaired PFS and OS. After multivariate analysis, PPC was independently associated with a worse prognosis for both survival endpoints. PPC was associated with a similar initial response but a higher rate of platinum resistance and shorter PFS and OS. Consideration of these results may be useful for patient counseling, trial stratification, and molecular comparisons.

A phase II study of the feasibility of sequential carboplatin (C) followed by paclitaxel (P) and gemcitabine (G) as first-line chemotherapy for stage Ic-IV ovarian (OC), fallopian tube (FTC), and primary peritoneal carcinoma (PPC)

5578 Background: We previously explored the feasibility of adding G to C + P in a phase II study, in which 4 cycles of C followed by 4 cycles of concurrent weekly P and G were given (BJC (2004) 91:627–32). Although highly active (med PFS 19.5m), the feasibility of this 1st-line regimen was limited by dyspnea during the weekly P+G phase. The current trial assessed whether the dyspnoea could be ameliorated by altering the schedule. Methods: Untreated FIGO stage Ic-IV OC, FTC and PPC patients (pts) were eligible. Chemotherapy (CTX) consisted of 4 cycles of C (AUC 7) q21 days, followed by 4 cycles of concurrent P (175 mg/m2) d1 and G (1,000 mg/m2) d1 and d8 q21 days. The primary endpoint of the study was the percentage of pts completing the planned 8 cycles of CTX. The planned sample size was 54 pts, based on a one stage single arm study design with 95% power to reject the null hypothesis (completion rate less than 60%), assuming a true completion rate of 80% using one-sided alpha=0.05. Results: All 54 pts were recruited between June 05 and June 06. Details for 44 pts are currently available for the C phase. 38% of these pts had one or more dose reduction (DR), and 68% had dose delays (DD). The commonest reason for DR and DD was neutropenia. Details for 33 pts are currently available for the P+G phase. 27% of these pts had a DR of P and 51% had a DR of G. 71% of pts omitted G on D8, and 64% had a DD. The commonest reasons for DR and DD were neutropenia and thrombocytopenia. Overall, the KM estimate of the percentage completing 8 cycles is 75% (95% CI 61%-89%) based on the current data. Dyspnoea (Grade 2 only) was observed in 4.5% and 3% pts during the C and P+G phases respectively. No significant treatment related CXR changes were observed. The overall response rate was 68% (95% CI 45–86%; 36% CR, 32%PR, 14% SD, 5%PD, 14% NE; n=22). The median follow-up is 7.5 months and the PFS at 8 months is 92% (95% CI 77–97%). Conclusion: This schedule appears to ameliorate the previously observed dyspnoea, while retaining comparable efficacy. The feasibility of this regimen is limited by myelosuppression which could potentially be overcome by: a) reducing the dose of gemcitabine to 750 mg/m2, or b) using prophylactic Peg-GCSF. [Table: see text]

Papillary serous carcinoma in ovaries of normal size: A clinicopathologic study of 20 cases and comparison with extraovarian peritoneal papillary serous carcinoma

Objective. The aim of this study was to compare the clinicopathological features of papillary serous carcinoma in ovaries of normal size and primary peritoneal carcinoma (PPC). Methods. Among 167 patients diagnosed with advanced primary serous ovarian carcinoma over a 9-year period, 20 patients with a normal ovarian size (not larger than 4 cm in the longest diameter) were selected for this study after a review of the pathologic materials. The clinicopathological characteristics of the patients were compared with those of seven patients with PPC, diagnosed using the GOG criteria during the same period. Results. All the patients with ovarian carcinoma and five of seven PPC patients had small ovarian tumors. There were few significantly different features between the two groups. The patients with ovarian carcinoma were younger than those with PPC (median age of 52 vs. 64 years, P = 0.007) and tended to have a lower baseline CA125 level (median value of 937 vs. 2870 U/mL, P = 0.097), less severe omental involvement ( P = 0.057), and a more complete response to adjuvant chemotherapy (89% vs. 57%, P = 0.064). Conclusions. Although the sample size was small, there was no meaningful difference between patients with papillary serous carcinoma in ovaries of normal size and PPC. Therefore, further studies will be needed to determine the relevance of the GOG rules in distinguishing between the two groups.

Follow-up of ovarian and primary peritoneal carcinoma: The value of physical examination in patients with pretreatment elevated CA125 levels

Objective. To assess the value of routine periodic physical examination in the follow-up of ovarian (OvC) and primary peritoneal carcinoma (PPC) patients with pretreatment elevated CA125 levels. Methods. Included were patients who had a pretreatment serum CA125 level above normal limits, had completed initial treatment, were in complete clinical remission on completion of the initial treatment and routinely attended the gynecologic oncology outpatient clinic. Recurrence was diagnosed when at least one of the following criteria was abnormal: symptoms, physical examination or elevated serum CA125 levels. Results. Of 69 patients, a recurrence was diagnosed in 43. Abnormal physical examination for diagnosis of recurrence yielded a sensitivity rate of only 34.9%. The diagnosis of recurrence was based on an abnormal physical examination alone in 2 (4.6%) patients. Conclusion. In OvC and PPC patients with elevated pretreatment CA125 levels, physical examination has a limited impact on the diagnosis of recurrence.

Primary peritoneal carcinoma—Uterine involvement and hysterectomy

Objective. To assess the frequency of uterine involvement in primary peritoneal carcinoma (PPC) and to describe selected clinical characteristics in patients with and without hysterectomy. Methods. All incident cases of histologically confirmed cancer of the ovary or peritoneum, diagnosed in Israeli Jewish women between March 1 1994 and June 30, 1999, were identified within the framework of a nationwide epidemiological study of these neoplasms. The study population was accrued through an active search of all newly diagnosed patients in all the departments of gynecology in Israel. The data of 81 PPC patients included in the present study were abstracted from medical records. Results. Hysterectomy was performed in 48 patients. These patients had a lower mean age (62.4 ± 9.4 vs. 66.9 ± 10.4; P = 0.05) at diagnosis and a higher rate of ≤ 2 cm residual disease (54.2% vs.24.2%; P = 0.02). Of those with hysterectomy, microscopic involvement was verified in all those with macroscopic involvement. Overall microscopic involvement was present in 28 (58.3%) of the patients who underwent hysterectomy. In the majority of them, only the serosa was involved. Macroscopic uterine involvement was present in 27 (33.3%) patients but in only 12% it was >2cm. The median survival in patients with hysterectomy was 36 months and in those without hysterectomy 29 months, this difference was statistically not significant ( P = 0.2). Conclusions. Our study indicates that in an unselected group of PPC patients 33% have any macroscopic uterine involvement. The therapeutic value of routine hysterectomy at the initial operation for PPC should be further investigated.

Third-line chemotherapy in platinum- and paclitaxel-resistant ovarian, fallopian tube, and primary peritoneal carcinoma patients.

Ovarian carcinoma is a malignant disease with a high rate of recurrence, necessitating repeated chemotherapy treatments. We conducted a retrospective study in patients with platinum- and paclitaxel-resistant ovarian, fallopian tubes and primary peritoneal carcinoma patients treated at M.D. Anderson Cancer Center. We evaluated the responses, progression-free intervals, and overall survival duration of 51 patients after third-line chemotherapy treatment. The overall response rate was 16% (eight cases) with 2% complete response rate (one case) and 14% partial response rate (seven cases). Stable disease was achieved in 31% (16 cases). The progression-free intervals of 24 patients who had response and stable disease was 7.4 months (range, 1.4-18.4 months). The median overall survival of all patients was 15.8 months (95% CI, 8.1-23.4 months). The median survival duration of eight responders was not significantly different from that of 43 nonresponders, 18.9 months (95% CI, 2.4-35.4 months) versus 15.8 months (95% CI, 6.4-25.2 months), respectively (P = 0.73). In conclusion, third-line chemotherapy in our study results in a modest response and prolongation of progression-free interval without obvious impact on survival. The decision to utilize third-line chemotherapy will be a balance of the limited efficacy, toxicity of the agents, and the expertise of the clinician.

Third-line chemotherapy in platinum- and paclitaxel-resistant ovarian, fallopian tube, and primary peritoneal carcinoma patients

Ovarian carcinoma is a malignant disease with a high rate of recurrence, necessitating repeated chemotherapy treatments. We conducted a retrospective study in patients with platinum- and paclitaxel-resistant ovarian, fallopian tubes and primary peritoneal carcinoma patients treated at M.D. Anderson Cancer Center. We evaluated the responses, progression-free intervals, and overall survival duration of 51 patients after third-line chemotherapy treatment. The overall response rate was 16% (eight cases) with 2% complete response rate (one case) and 14% partial response rate (seven cases). Stable disease was achieved in 31% (16 cases). The progression-free intervals of 24 patients who had response and stable disease was 7.4 months (range, 1.4–18.4 months). The median overall survival of all patients was 15.8 months (95% CI, 8.1–23.4 months). The median survival duration of eight responders was not significantly different from that of 43 nonresponders, 18.9 months (95% CI, 2.4–35.4 months) versus 15.8 months (95% CI, 6.4–25.2 months), respectively (P= 0.73). In conclusion, third-line chemotherapy in our study results in a modest response and prolongation of progression-free interval without obvious impact on survival. The decision to utilize third-line chemotherapy will be a balance of the limited efficacy, toxicity of the agents, and the expertise of the clinician.

Comparison between primary peritoneal and epithelial ovarian carcinoma: a population-based study

ObjectiveThis study was undertaken to characterize primary peritoneal carcinoma (PPC) compared with ovarian carcinoma (OvC). Study designWithin the framework of a nationwide epidemiologic Israeli study, 95 PPC patients were identified and compared with 117 FIGO stage III-IV epithelial OvC patients matched by age and continent of birth. Data were abstracted from medical records and personal interviews. ResultsOur data confirm the similarities between PPC and OvC. A higher rate of abdominal distention, volume of ascites, and malignant cells in ascitic fluid and lower rate of pelvic palpable mass and personal breast cancer history were found in the PPC compared with the OvC group. The overall survival was similar in both groups (30-33 months). In optimally cytoreduced patients, survival was better in the OvC group. Diameter of residual disease was associated with better survival only in the OvC group. ConclusionThe clinical differences do not enable a preoperative distinction between the neoplasms.