Abstract
In Reply.—We certainly appreciate Dr Levitt's concern about the three patients we reported. These three patients, however, had stage IV (advanced metastatic) disease and they were thus appropriately treated with combination chemotherapy. Furthermore, all three patients achieved complete remission, which continued for greater than 30,19, and 16 months, respectively. This remission duration is greater than the median duration of survival for patients with advanced metastatic disease and is therefore remarkable in itself for three sequential patients. The more significant feature was that the combination chemotherapy shrank the primary masses, allowed for simple localized surgery to produce hygienic results, and perhaps more interestingly, this debulking procedure in two patients after they had achieved a stable partial response allowed the remaining measurable metastatic disease to respond even further and the patients achieved complete remission. It would be logical to hypothesize that a similar event may occur with micrometastases, and thus our