3.1 Treatment
The flowchart of treatment administered, and the outcome is illustrated in Figure 2. Rapid COJEC was administered over a median duration of 91 days (IQR: 83.5, 96). The 28 patients received 219 cycles of rapid COJEC. Episodes of febrile neutropenia were recorded in 18 (8%) cycles, resulting in a single (3.6%) mortality. The response was assessed following rapid COJEC in 25 patients. Remission was observed in 21 (84%) patients, with CR in nil, VGPR in 4, and PR in 17 patients. Four (16%) patients did not achieve remission with MR and PD in 2 each.
Surgery was performed in 18 (72%) patients, including debulking in 11 (61%) and a complete resection in 7 (39%). In 7 patients, surgery was not performed due to a) progressive disease at metastatic sites (n=2), b) lack of remission in bone marrow (n=2), c) reduction in the size of the primary tumor to a small size deemed futile for surgical resection (n=2) or, d) treatment abandonment (n=1). Seventy-two cycles of TVD were administered to 20 patients. Thirty-three (46%) episodes of febrile neutropenia occurred during the administration of TVD, with a single (5%) mortality. Radiotherapy to the primary tumor, followed by six, 2-weekly cycles of isotretinoin were administered to 17 patients.