Outcome issues in ovarian cancer

Ovarian cancer is the leading cause of death from a gynecologic malignancy in the United States. Most patients present with advanced disease and are treated with a combination of surgery and chemotherapy. Recently, paclitaxel has been identified as a highly active agent in this disease, and has produced a meaningful impact upon survival for patients with advanced disease. However, numerous questions remain regarding the optimal combination chemotherapy regimen and the integration of surgery into overall management. Furthermore, while patients with early-stage disease have an improved prognosis, there currently is no evidence that screening the general population is beneficial. Similarly, there is no evidence that any form of additional therapy for patients with advanced disease following their surgery and chemotherapy is beneficial. Controversy exists with regard to the benefit of second-look procedures to assess the impact of therapy and of close surveillance to select patients who may be candidates for additional therapy.