A common treatment for vulvar pre-malignant conditions is surgery, which can be disfiguring and painful. Alternatives to surgery have long been sought but none have been effective and easy to use. Investigators at several Netherlands institutions, reporting in this week's New England Journal of Medicine, looked at the effectiveness of imiquimod 5% cream, a topical immune-response modulator, for the treatment of this condition.

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Dr. Teoh and colleagues from UCSF, Stanford and UCI reviewed the SEER database between 1988 and 2001 to try to answer this question.  The National Cancer Institute's SEER, Surveillance Epidemiology and End Results, is the largest registry of data available and compiles data from all reporting tumor registries from hospitals nationwide. Their review was presented at the latest Society of Gynecologic Oncologists meeting this month in Tampa Florida.

During the period reviewed there were 28,082 women registered with epithelial ovarian cancer. Of these, 5% had clear cell, 49% papillary serous, 13% endometriod, 10% mucinous and 23% unspecified.  

The conclusions? Women with clear cell ovarian cancer are diagnosed at an earlier age, are more likely to be Asian, and have a worse prognosis compared to women with serous cancers (the most common type).  

 

According to a study presented at the Society of Gynecologic Oncologists March 2008 meeting in Tampa, chemotherapy dose reduction is associated with poor survival in advanced ovarian cancer. This is not shocking new information, but is a reminder that there is indeed a need to balance aggressive treatment with quality of life.

Dr. Chura and associates looked at those patients who had to have their doses of chemotherapy either reduced or delayed for medical reasons. These reasons were usually related to bone marrow suppression from the chemotherapy.

Patients who had to have their doses reduced or delayed had a significantly worse  progression free survival, although overall survival was not as clearly affected.

The message?  Although high dose chemotherapy does not work any better than standard dose chemotherapy, reducing the dose or lengthening the time between standard chemotherapy administration can reduce your chances of living longer. If there is a delay or dose reduction required, it helps to discuss this with your physician to see if anything can be done with bone marrow supporting drugs. Every situation is different, but this is something to consider in general.