[Chemotherapy of ovarian carcinoma]

It can be demonstrated by giving examples that the response of ovarial carcinomas to chemotherapy is most variable. At the Gynecologic Hospital of the University of Freiburg, the prognosis of extensive ovarial carcinomas has improved during the past years, possibly due to a more consequent and aggressive chemotherapy. The primary operations, however, have become more radical, too, but this depends directly on the histological type and especially the degree of differentiation of the tumor. The review of literature shows that a conventional chemotherapy today is expected to produce a remission rate of 40% and that it has not been clarified yet if a combination of different cytostatic drugs is finally superior to monotherapy. Chemotherapy with cisplatine seems to bring about more remissions, especially more total remissions. But the criterion of remission rate is not sufficient to judge the clinical practicability of a chemotherapy. One has to take into consideration the unjudgeable cases, the patients breaking up therapy, and the cases in which chemotherapy in this form cannot be performed or continued. Under this criteria, too, modern chemotherapy with cisplatine seems to be superior to former chemotherapies. On the other hand, chemotherapy of progressive and recurrent ovarial carcinomas is still completely unsatisfactory. Another unsolved problem is the maintenance of remission, and it should be investigated if radiotherapy can play an important role in this connection. A second-look operation is only indicated if a remission is clearly demonstrated, but these cases have the same good prognosis as patients submitted to primary radical surgery. The crucial point is therefore the first response of ovarial carcinomas to chemotherapy, and this depends on different clinical and morphological factors. Today a biochemical evaluation of chemoresistance is probably possible by modern methods. This is being investigated in a prospective study.