Cisplatin, adriamycin and ifosfamide-based combination chemotherapy for gynecological cancers derived from the extended müllerian system.

Their histogenetic similarity suggests that a group of malignant tumors may have a common sensitivity to a cytotoxic chemotherapy. Seventy patients with a variety of gynecological cancers arising from the uterine cervix, endometrium, ovary and pelvic peritoneum were treated with a combination of cisplatin, adriamycin and ifosfamide (PAI). As schedule modifications, PAI plus bleomycin for cancers containing squamous components and PAI plus etoposide for nonepithelial malignancies were recommended. In twenty-five evaluable cases, including 12 recurrent tumors after previous radiation therapy or PAC (cisplatin, adriamycin and cyclophosphamide) chemotherapy, the total response rate was 95% for epithelial cancers (vaginal cancer: 1/1, cervical: 9/10, endometrial: 2/2, ovarian: 6/6 and peritoneal: 2/2), and 100% for nonepithelial malignancies including one uterine leiomyosarcoma, one uterine mixed Müllerian tumor and one extragonadal mixed Müllerian tumor. The survival rates of patients with non measurable lesion were 100% for cervical cancer (the observation period: 65-879 days), 92.9% for endometrial cancer (96-975 days) and 88.9% for ovarian cancer (148-976 days). The hematological toxicity of this treatment was severe but acceptable. The results obtained indicate that a wide range of gynecological cancers originating in the primary and secondary Müllerian tissues (extended Müllerian system) must have a similar sensitivity to cytotoxic treatment with a PAI-based combination chemotherapy.