Surgery is often the initial treatment of choice for ovarian cancer, provided that patients are medically fit. Patients who are not candidates for optimal debulking should be considered for neoadjuvant chemotherapy, followed by interval debulking surgery and further chemotherapy. Patients who are not fit for surgery may be given chemotherapy and considered for surgery later, or primarily treated with chemotherapy.
The aim of surgery is to confirm the diagnosis, define the extent of disease, and resect all visible tumor. The role of cytoreduction was demonstrated by Griffiths in 1975 and has been confirmed by many others. Surgery should be used in conjunction with chemotherapy with a taxane and a platinum compound (eg, paclitaxel plus carboplatin). For more information on chemotherapy regimens, see Ovarian Cancer Treatment Protocols.
The National Comprehensive Cancer Network recommends three to six cycles of intravenous taxane/carboplatin adjuvant chemotherapy for high-risk stage IA, IB, or IC epithelial ovarian cancer. For stage II-IV disease, the recommended options include intraperitoneal chemotherapy, in patients with < 1 cm optimally debulked stage II and III disease; or intravenous taxane/carboplatin for six cycles. In addition, completion surgery, as indicated by tumor response and potential resectability, may be used in selected patients. Paclitaxel and docetaxel are usually dosed at 175 mg/m2 and 60-75 mg/m2, respectively. Cisplatin at 50-75 mg/m2 can be substituted for carboplatin. Increasing the dose intensity of cisplatin does not improve progression-free survival or overall survival compared with standard chemotherapy.
Babies conceived after treatment with chemotherapy do not appear to be at increased risk for congenital anomalies. The necessity for chemotherapy during a preexisting pregnancy fortunately is rare, but antifolate drugs, such as methotrexate, probably should be avoided during the first trimester.
Radiation has not been widely accepted as a routine treatment modality in the initial treatment of patients with epithelial ovarian cancer, despite reports of efficacy for higher-risk stage I and II disease and in stage III disease where small-volume residual disease is present after surgery. In selected cases, pelvic diseases may respond to palliative dosing regimens with minimal toxicity.
For more on the treatment of ovarian cancer, read here.
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Cite this: Michel E. Rivlin. Fast Five Quiz: Ovarian Cancer - Medscape - Sep 27, 2018.