Ovarian Cancer Controversies: Examining the Options After Primary Treatment

Overall 5-year survival for patients with epithelial ovarian cancer drops from 88% for stages I and II, to 36% for stage III, and to 17% for stage IV. Over the past 15 years, mortality rates from ovarian cancer have fallen slightly for women under age 65 and have risen slightly for women older than 65. Since paclitaxel was approved for commercial use in 1992, we do not yet know how it will affect 5-year survival figures. The usefulness of primary adjuvant chemotherapy in women with early stage I or II ovarian cancer is unclear, but for women with advanced ovarian cancer, primary treatment should include 6 courses of platinum/paclitaxel chemotherapy, followed by second-look surgery to help women and their physicians decide on appropriate consolidation therapy. Potential consolidation treatments--including continuation of intravenous platinum and paclitaxel therapy, intraperitoneal cisplatin and/or paclitaxel therapy, topotecan, and high-dose chemotherapy with hematologic support--offer the promise of rendering primary therapy more effective. For follow-up after primary therapy, the benefits of routine CA-125 and imaging studies have not been established. In this clinician's practice, patients who have no evidence of disease are followed with office visits and physical examination every 6 months for 5 years; CA-125 levels or order imaging studies are not routine unless required by protocol. Women with symptomatic, recurrent disease may be treated with chemotherapy and, in some cases, surgery. Maintenance of quality of life and palliation of symptoms are crucial.