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- Wed Mar 04, 2009 8:39 am
My mother was diagonised clear cell OVCA in march 06 (Total Hysterectomy + 6 cycles of cisplatin +Taxol) had suffered recurrences in Dec 2007 in Omentum (Dissected and chemotherapy with liposmal dixrubicin + Cyclophosphamide) and September 08 ( One 3cmx2.5 cm lymph node at paraaortic region) Her CA went up to 537 and this is the first time her CA crossed 150 during 3 years.
After so many options like opn,alternative teatment for just one Lymph node we emphasized another round of chemo and She received 2 cyles of Carbo+Gemzar and Her CA 125 is 138 now just after 10 days of last dose of 2nd cycle.
We are planning to go for another cycle but my mom is reluctant to go for another. Though another can be managed...
Do you have any idea what whouold be our next step? Should we go for another surgery though she is not liking to take the suffering again of surgery.
Otherwise she is energetic,agile and have no problems at all. Please advise.
| Dr. Tamer Fouad
- Thu Mar 05, 2009 4:15 pm
I am not really in a position to advise you at all. What I can do is explain a few points regarding the management of ovarian cancer. Platinum regimens (especially carboplatin-taxol) is the 1st line regimen for ovarian cancer whether in the adjuvant setting or after after the disease has recurred if there is at least a 6 months platinum free period as well as in the metastatic setting.
Carboplatin-gemcitabin has also been associated with similar outcome to carboplatin taxol but the comparision is indirect as these regimens have not been compared to each other in the same clinical trial. One of the main reasons to use carbplatin gemcitabin is in patients with residual neurotoxicity due to previous taxol.
That said, the mainstay of treatment in ovarian cancer is surgery but only when surgery can achieve what is known as optimal cytoreduction (ie, size of the tumor left behind after surgery is <1cm). If optimal cytoreduction is not achievable the role of surgery becomes doubtful.
So its really up to her surgeon to decide whether optimal cytoreduction is achievable depending on the disease present in her recent scans. Again, the results of surgery in the setting of recurrence (2ry cytoreduction) is not acceptable by all and most surgeons require that patients receive chemotherapy first as a sort of invivo test for chemosensitivity.
She seems to be doing really well with gemcitabin-carboplatin and it is a relatively less toxic regimen. Why does she wish to avoid receiving additional cycles? I would have thought the results of her markers would be reassuring.