Therapeutic strategy in the management of stage II-IV epithelial ovarian carcinoma

To investigate the optimal time of debulking in stage/II to stage IV epithelial ovarian carcinoma, considering corresponding advantages of both surgery and chemotherapy.

From January 1989 to December 1996, ninety-five stage II to stage IV ovarian cancer patients were treated under two different regimens. Group A-76 cases (2 cases in IIa stage, 4 cases in IIb stage, 6 cases in IIc stage, 58 cases in IIIc stage and 7 cases in IV stage) was managed according to a traditional surgery-chemotherapy regimen; and group B-19 cases (17 cases in IIIc stage and 2 cases in IV stage) was managed with a chemotherapy-surgery-chemotherapy regimen.

The optimal debulking rate (no macroscopic residual or residual < 2 cm) in group A was significantly lower than in group B, being 32.9% (25/76) and 68.4% (13/19), respectively (P < 0.001). The average survival time of those with a residual focus > 2 cm was shorter than those with a residual focus < 2 cm, in both groups. Sixteen out of the 51 patients with a residual focus > 2 cm had a second debulking operation, among whom 7 had preoperative chemotherapy. All of these 7 patients had either no residuals or residual < 2 cm. In 9 cases without preoperative chemotherapy, the residuals were all > 2 cm. The average survival time among these two groups were significantly different (P < 0.01).

(1) For those patients in whom optimal debulking was clinically assessed to be possible, timely operation is mandatory. (2) For those inoperable advanced cases, chemotherapy-surgery-chemotherapy regimen is recommended. (3) For those with residuals > 2 cm and were assessed to be difficult to eradicate during second-look operation, multi-route chemotherapy (intro-arterial, intraperitoneal, and systematic) should be given before going on the second debulking operation. Positive attitude and proper regimen would offer better results. (4) A multicenter prospective study would give more decisive conclusion.