Ovarian Epithelial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Stage
Ovarian Epithelial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Stage I and Stage II Ovarian Epithelial Cancer Treatment
Treatment options:
In two large European trials, European Organization for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm (EORTC-ACTION) and International Collaborative Ovarian Neoplasm (MRC-ICON1 [NCT00002477]), patients with stage IA and stage IB (grades II and III), all stage IC and stage II, and all stage I and stage IIA clear cell carcinoma were randomly assigned to adjuvant chemotherapy or observation. Data were reported individually and in pooled form.[12,13,14]
Understanding Ovarian Cancer -- Symptoms
Although ovarian cancer rarely produces symptoms in its earliest stages, eventual warning signs may include: Vague digestive disturbances, such as mild indigestion, bloating, feeling of fullness, or loss of appetite, gas Diarrhea, constipation, or a frequent need to urinate Pain or swelling in the abdomen, or pain in the lower back or pelvic pressure Vaginal bleeding between menstrual periods or after menopauseSymptoms associated with advanced ovarian cancer include...
Read the Understanding Ovarian Cancer -- Symptoms article > >
The EORTC-ACTION trial required at least four cycles of carboplatin or cisplatin-based chemotherapy as treatment. Although surgical staging criteria were monitored, inadequate staging was not an exclusion criterion. Recurrence-free survival (RFS) was improved in the adjuvant chemotherapy arm (hazard ratio [HR], 0.63; P = .02), but overall survival (OS) was not affected (HR, 0.69; 95% confidence interval [CI], 0.44-1.08; P = .10). OS was improved by chemotherapy in the subset of patients with inadequate surgical staging.
The MRC-ICON1 trial randomly assigned patients to six cycles of single-agent carboplatin or cisplatin or platinum-based chemotherapy (usually cyclophosphamide, doxorubicin, and cisplatin) versus observation and had similar entry criteria to the EORTC-ACTION trial; however, the MRC-ICON1 trial did not monitor whether adequate surgical staging was performed. Both RFS and OS were significantly improved; 5-year survival figures were 79% with adjuvant chemotherapy versus 70% without adjuvant chemotherapy.
- If the tumor is well differentiated or moderately well differentiated, surgery alone may be adequate treatment for patients with stage IA and IB disease. Surgery should include hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Additionally, the undersurface of the diaphragm should be visualized and biopsied; pelvic and abdominal peritoneal biopsies and pelvic and para-aortic lymph node biopsies are required and peritoneal washings should be obtained routinely.[1] In selected patients who desire childbearing and have grade I tumors, unilateral salpingo-oophorectomy may be associated with a low risk of recurrence.[2]
- If the tumor is grade III, densely adherent, or stage IC, the chance of relapse and death from ovarian cancer is as much as 30%.[3,4,5,6] Clinical trials evaluating the following treatment approaches have been performed:
- Intraperitoneal P-32 or radiation therapy.[1,7,8]
- Systemic chemotherapy based on platinums alone or in combination with alkylating agents.[1,7,9,10,11]
- Systemic chemotherapy based on platinums with paclitaxel.
In two large European trials, European Organization for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm (EORTC-ACTION) and International Collaborative Ovarian Neoplasm (MRC-ICON1 [NCT00002477]), patients with stage IA and stage IB (grades II and III), all stage IC and stage II, and all stage I and stage IIA clear cell carcinoma were randomly assigned to adjuvant chemotherapy or observation. Data were reported individually and in pooled form.[12,13,14]
Recommended Related to Ovarian Cancer
Understanding Ovarian Cancer -- Symptoms
Although ovarian cancer rarely produces symptoms in its earliest stages, eventual warning signs may include: Vague digestive disturbances, such as mild indigestion, bloating, feeling of fullness, or loss of appetite, gas Diarrhea, constipation, or a frequent need to urinate Pain or swelling in the abdomen, or pain in the lower back or pelvic pressure Vaginal bleeding between menstrual periods or after menopauseSymptoms associated with advanced ovarian cancer include...
Read the Understanding Ovarian Cancer -- Symptoms article > >
The EORTC-ACTION trial required at least four cycles of carboplatin or cisplatin-based chemotherapy as treatment. Although surgical staging criteria were monitored, inadequate staging was not an exclusion criterion. Recurrence-free survival (RFS) was improved in the adjuvant chemotherapy arm (hazard ratio [HR], 0.63; P = .02), but overall survival (OS) was not affected (HR, 0.69; 95% confidence interval [CI], 0.44-1.08; P = .10). OS was improved by chemotherapy in the subset of patients with inadequate surgical staging.
The MRC-ICON1 trial randomly assigned patients to six cycles of single-agent carboplatin or cisplatin or platinum-based chemotherapy (usually cyclophosphamide, doxorubicin, and cisplatin) versus observation and had similar entry criteria to the EORTC-ACTION trial; however, the MRC-ICON1 trial did not monitor whether adequate surgical staging was performed. Both RFS and OS were significantly improved; 5-year survival figures were 79% with adjuvant chemotherapy versus 70% without adjuvant chemotherapy.
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