This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tropé, C. Articles by Kaern, J. Search for Related Content PubMed PubMed Citation Articles by Tropé, C. Articles by Kaern, J. Social Bookmarking                            What's this?

Adjuvant Chemotherapy for Early-Stage Ovarian Cancer: Review of the Literature

Claes Tropé, Janne Kaern

From the Department of Gynecologic Oncology, The Norwegian Radium Hospital; Faculty Division, the Norwegian Radium Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway

Address reprint requests to Claes Tropé, MD, PhD, Department of Gynecologic Oncology, the Norwegian Radium Hospital, Montebello, 0310 Oslo, Norway; e-mail: c.g.trope{at}medisin.uio.no

Purpose This overview summarizes studies with acceptable quality and validity and presents a synthesis of the effectiveness on adjuvant therapy after surgery for early ovarian cancer (EOC) patients.

Methods The literature published between 1970 and 2006 was identified systematically by computer-based searches in MEDLINE and Cochrane library.

Results Twenty-two prospective randomized studies were analyzed, which included 4,626 patients. No difference between adjuvant chemotherapy (AC) and radiotherapy was found. There is agreement on that patients with stage IA, grade 1 tumors have excellent survival and do not need postsurgical therapy. The International Collaborative Ovarian Neoplasm 1/Adjuvant Chemotherapy in Ovarian Neoplasm trials were the first to show an effect on survival of AC, but in patients with adequate surgical staging, there was no additional effect of AC. For patients who are staged incompletely at the time of initial surgery, completion of the staging procedure with either laparoscopy or laparotomy is a reasonable approach before a final decision is made regarding the need for AC. If full staging cannot be performed due to medical contraindication or patient refusal, consideration of AC is reasonable in selected patients. Using prognostic variables such as grade, International Federation of Gynecology and Obstetrics substage, pretreatment of CA-125 30 U/mL, and DNA ploidy, it is possible to divide patients into risk groups to avoid overtreatment. Gynecologic Oncology Group study 157 suggests that it may be possible to minimize chemotherapy-induced toxicity by using three instead of six cycles of AC, although it is not known fully whether this will compromise effectiveness.

Conclusion Future randomized studies in EOC will include the investigation of new targeted therapies and new prognostic factors in adequately staged patients.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Cvancarova, S. O. Samuelsen, H. Magelssen, and S. D. Fossa Reproduction Rates After Cancer Treatment: Experience From the Norwegian Radium Hospital J. Clin. Oncol., January 20, 2009; 27(3): 334 - 343. [Abstract] [Full Text] [PDF]

				D. Yamada The Role of Surgery in Ovarian Cancer Management ASCO Educational Book, January 1, 2009; 2009(1): 302 - 307. [Abstract] [Full Text] [PDF]

				S. Marchini, P. Mariani, G. Chiorino, E. Marrazzo, R. Bonomi, R. Fruscio, L. Clivio, A. Garbi, V. Torri, M. Cinquini, et al. Analysis of Gene Expression in Early-Stage Ovarian Cancer Clin. Cancer Res., December 1, 2008; 14(23): 7850 - 7860. [Abstract] [Full Text] [PDF]

				S. A. Cannistra and W. P. McGuire Progress in the Management of Gynecologic Cancer J. Clin. Oncol., July 10, 2007; 25(20): 2865 - 2866. [Full Text] [PDF]