Adjuvant treatment of early stage ovarian carcinoma

Surgery is considered the mainstay of diagnosis and treatment in early ovarian carcinoma. Only accurate staging laparotomy can detect subclinical metastases remote from the ovary, thus allowing the identification of the truly early tumors. However the complete macroscopic removal of neoplastic disease is not synonymous with cure. Many postoperative treatments have been carried out in order to improve the prognosis of patients with stage I-II ovarian carcinoma. The present paper reviews the main clinical trials on the employment of external radiotherapy, intraperitoneal radioisotope instillation and systemic chemotherapy in the management of early ovarian carcinoma. The patients appear to benefit from adjuvant treatment, with the exception of those with stage I Ai-I Bi well differentiated tumor, even if there is no agreement in literature about the superiority of a particular therapeutic approach. However the high response rates obtained in patients with advanced ovarian carcinoma with DDP containing combination chemotherapy have suggested to clinicians the use of such treatment also in early stage tumors. In our experience none of the 11 stage I ovarian cancer patients, who received 6 courses of DDP-based combination chemotherapy, have developed recurrent disease after a median follow-up of 54 months (with a range from 24 to 72 months).