About one quarter of all ovarian cancers are caught while confined to the ovaries, when five-year survival is 85 percent. But the therapeutic benefit of adjuvant chemotherapy remains controversial. All physicians agree that surgery that includes staging is critical to survival. Some doctors may prefer not to offer chemotherapy for their patients, since eight in ten are adequately treated by surgery alone. They could argue that giving all stage I patients chemotherapy would lead to unnecessary adverse events with no survival benefit for the majority of patients.
Given the controversy, Laurie Elit, M.D., of the Juravinski Regional Cancer Centre in Ontario, Canada and her colleagues conducted a meta-analysis of RCT data published since 1965.
First, adequate surgical staging was a prognostic factor for cancer survival. Most studies in this review did not show adequate staging of patients. Second, patients who received any adjuvant chemotherapy had a lower risk of death (relative risk, 0.74) and recurrence (relative risk, 0.70) than those who did not receive chemotherapy. However, insufficient data and conflicting data exist regarding the optimal regimens (e.g., three versus six cycles), optimal doses, and the role of adjuvant radiotherapy.
The authors strongly recommend that women receive appropriate surgical staging: "women with optimally staged stage I ovarian cancer, a pathology review by a gynecologic pathologist, and good prognostic factors (stage Ia or stage Ib grade 1) have an excellent prognosis without adjuvant chemotherapy." They add: "There is evidence adjuvant chemotherapy improves survival and decreases recurrence rates. What remains to be defined is the population of stage I patients who would most benefit from adjuvant therapy, the optimal chemotherapy regimen, and the dose and duration of treatment."
Article: "Systematic Review of Adjuvant Care for Women with Stage I Ovarian Carcinoma," Laurie Elit, Alexandra Chambers, Anthony Fyles, Allan Covens, Mark Carey, Michael Fung Kee Fung, CANCER; Published Online: September 27, 2004 (DOI: 10.1002/cncr.20595); Print Issue Date: November 1, 2004.
Cancer