Treatment of recurrent ovarian cancer

Recurrent ovarian cancer is a common clinical problem and the management of each patient must be individualized. Diagnosis is usually based on a progressively rising CA-125 titre, and a CT scan of the pelvis and abdomen, together with a chest X-ray should be performed in this situation. Although there is no study to support immediate treatment in the asymptomatic patient, our approach is to commence such patients on Tamoxifen. Chemotherapy is reserved for symptomatic patients or those who progress on Tamoxifen. The choice of non-platinum second or subsequent line chemotherapy is based on many factors including likelihood of benefit, potential toxicity, schedule and convenience to the patient, as well as organ function and residual toxicity from prior treatment. Aggressive secondary cytoreductive surgery can significantly prolong survival in those with a disease-free interval of 24 months or more, and in those in whom all macroscopic disease can be removed. Radiation therapy to the tumour bed following resection of localized disease may be beneficial in selected patients. Quality of life issues are particularly important for this group of patients and have not been adequately studied. Communication regarding the objectives of therapy is important, and the multidisciplinary approach should include palliative care and psycho-social support, in addition to the more traditional medical options.