Questioning current policies for the curative management of ovarian carcinoma

Despite major advances in the understanding of the natural history and mode of the spread of ovarian carcinoma, and in the development of new and effective techniques for its radiation and chemotherapy, the cure rates of this disease have not changed substantially over the last two decades. The disappointing results of treatment raise serious questions regarding the validity of some of the current strategies and policies for the management of ovarian carcinoma. This review discusses the need for a new staging classification system, the indications for initial maximal tumor reductive surgery and second-look laparotomy, the curative potentials of postoperative radiation or chemotherapy when employed as single modalities, and the causes of failure of combined modality treatment protocols. The therapeutic value of new experimental approaches, such as i.p. instillations of chemotherapy and/or monoclonal antibodies, when combined with conventional treatments, are discussed.