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.