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Chapter 093. Gynecologic Malignancies (Part 4)

Patients with stage I disease, no residual tumor, and well or moderately differentiated tumors need no adjuvant therapy after definitive surgery, and 5-year survival exceeds 95%. For all other patients with early disease and those stage I patients with poor prognosis histologic grade, adjuvant platinum-based therapy is warranted. Large prospective randomized trials have demonstrated that adjuvant therapy improves disease-free and overall survival by 8% (82% vs. 74%, p = .008). For patients with advanced (stage III) disease but with limited or no residual disease after definitive cytoreductive surgery (about half of all stage III patients), the primary therapy is platinum-based combination. | Chapter 093. Gynecologic Malignancies Part 4 Patients with stage I disease no residual tumor and well or moderately differentiated tumors need no adjuvant therapy after definitive surgery and 5-year survival exceeds 95 . For all other patients with early disease and those stage I patients with poor prognosis histologic grade adjuvant platinum-based therapy is warranted. Large prospective randomized trials have demonstrated that adjuvant therapy improves disease-free and overall survival by 8 82 vs. 74 p .008 . For patients with advanced stage III disease but with limited or no residual disease after definitive cytoreductive surgery about half of all stage III patients the primary therapy is platinum-based combination chemotherapy. Approximately 70 of women respond to initial combination chemotherapy and 40-50 have a complete regression of disease. Unfortunately only about half of these patients are free of disease if surgically restaged. Although a variety of combinations are active a randomized prospective trial of paclitaxel and cisplatin compared to paclitaxel and carboplatin in patients with optimally resected advanced disease demonstrated equivalent disease-free and overall survivals but with significantly reduced toxicity with the carboplatin combination. This regimen of paclitaxel 175 mg m2 by 3-h infusion and carboplatin dosed to an AUC area under the curve of 7.5 is the preferred treatment choice for patients with previously untreated advanced-stage disease. Three randomized trials using intraperitoneal IP chemotherapy have demonstrated improved disease-free and overall survival compared to the intravenous administration of the same drugs. However the increased toxicity neuropathy nephropathy and catheter complications is significant and only about 40 of patients were able to receive full courses of therapy. Furthermore the optimal dose and schedule of IP therapy has not been established nor have any of the IP regimens been prospectively compared to the .