Læknablaðið - 15.09.1983, Blaðsíða 64

232
LÆKNABLADIÐ
malignant tumours of the female genital tract. The
sign and symptoms of the disease are non-specific
and the diagnosis is most often made at surgery
when most of the patients are at an advanced stage
of the disease. Surgery together with chemotherapy
or radiotherapy, or both in combination, is the main
form of treatment. The following statements are
based on the results of a study of Prognostic Factors
and the Effects of Combined Treatments carried out
at the University Hospital of Lund (26). Young
patients with well or moderately differentiated
stage Ia tumours can be treated with unilateral
salpingo-oophorectomy, if wedge-resection of the
unaffected ovary shows normal tissue. The value of
hysterectomy in stage I is doubtful and ought only
to be performed in stages II and III if this operation
leads to surgical radicality or minimal residual
disease. Infracolic omentectomy should be perfor-
med as a staging operation. Patients primarly
judged inoperable should be biopsied and reopera-
ted after preoperative treatment with radiotherapy
or combination chemotherapy. Postoperative treat-
ment does not seem to improve cases of well
differentiated tumours in stages Ia with no extracy-
stic excrescences and intact tumour capsule. Accep-
table results are obtained irrespective of histologic
type in well or moderately differentiated tumours in
stage I and Ila treated with five malphalan infusions
at four weeks intervals. Chemotherapy given prior
to postoperative radiotherapy gives no advantages,
but chemotherapy after given radiotherapy does. In
advanced poorly differentiated stage III ovarian
tumours the effect of combination chemotherapy
are significantly higher than the effects of radiother-
apy and single drug chemotherapy. The effect of
combination chemotherapy and radiotherapy on
operability are much the same while the effect of
single drug chemotherapy is low. In a multivariate
statistical analysis, using survival as the dependent
variable, the following three factors are found to be
of significance: the histologic grade, the size of the
residual tumour after surgery, and the stage of
tumour progression. Stage Ila had the same survival
rate as Stage I of this disease. The state of the
tumour capsules in Stage I had no prognostic effect.
Ascites did not affect survival in stages I and II. The
histologic type only affects survival in patients with
large residual tumours (>2 cm). A prognostic-
classification is proposed for ovarian cancer, based
on the above results using the tumour grading,
residual tumour and the FIGO stages.
HEIMILDIR
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