Adjuvant therapy of early stage (stage I and II) epithelial ovarian, fallopian tubal, or peritoneal cancer
- Thomas J Herzog, MD
Thomas J Herzog, MD
- Clinical Director
- University of Cincinnati Cancer Institute
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Epithelial cancers of ovarian, fallopian tubal, and peritoneal origin exhibit similar clinical characteristics and behavior. As such, these are often combined and define epithelial ovarian cancer (EOC) in clinical trials and clinical practice. This topic will consider all three tumor origins under the heading EOC.
EOC is the most common cause of death among women with gynecologic malignancies and the fifth leading cause of cancer death in women in the United States. Only approximately 25 percent of women will be diagnosed with early stage ovarian cancer, either confined to the ovary (stage I) or confined to the pelvis (stage II). For women with EOC confined to the ovary (IA or IB) and/or well-differentiated (grade 1) tumors, prognosis is excellent with survival of at least 90 percent following surgery alone [1,2]. For all others, adjuvant chemotherapy is recommended.
This section will review adjuvant therapy for early stage EOC. Initial surgical management, adjuvant therapy for women with advanced (stage III or IV) ovarian cancer, and chemotherapy for women with recurrent disease are discussed separately.
- Young RC, Walton LA, Ellenberg SS, et al. Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials. N Engl J Med 1990; 322:1021.
- Ahmed FY, Wiltshaw E, A'Hern RP, et al. Natural history and prognosis of untreated stage I epithelial ovarian carcinoma. J Clin Oncol 1996; 14:2968.
- Chan JK, Tian C, Teoh D, et al. Survival after recurrence in early-stage high-risk epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 2010; 116:307.
- Vergote IB, Vergote-De Vos LN, Abeler VM, et al. Randomized trial comparing cisplatin with radioactive phosphorus or whole-abdomen irradiation as adjuvant treatment of ovarian cancer. Cancer 1992; 69:741.
- Chan JK, Tian C, Monk BJ, et al. Prognostic factors for high-risk early-stage epithelial ovarian cancer: a Gynecologic Oncology Group study. Cancer 2008; 112:2202.
- Elit L, Chambers A, Fyles A, et al. Systematic review of adjuvant care for women with Stage I ovarian carcinoma. Cancer 2004; 101:1926.
- Winter-Roach BA, Kitchener HC, Lawrie TA. Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database Syst Rev 2012; :CD004706.
- Trimbos B, Timmers P, Pecorelli S, et al. Surgical staging and treatment of early ovarian cancer: long-term analysis from a randomized trial. J Natl Cancer Inst 2010; 102:982.
- Trimbos JB, Vergote I, Bolis G, et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Natl Cancer Inst 2003; 95:113.
- http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf (Accessed on November 03, 2011).
- Bolis G, Colombo N, Pecorelli S, et al. Adjuvant treatment for early epithelial ovarian cancer: results of two randomised clinical trials comparing cisplatin to no further treatment or chromic phosphate (32P). G.I.C.O.G.: Gruppo Interregionale Collaborativo in Ginecologia Oncologica. Ann Oncol 1995; 6:887.
- Young RC, Brady MF, Nieberg RK, et al. Adjuvant treatment for early ovarian cancer: a randomized phase III trial of intraperitoneal 32P or intravenous cyclophosphamide and cisplatin--a gynecologic oncology group study. J Clin Oncol 2003; 21:4350.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Adams G, Zekri J, Wong H, et al. Platinum-based adjuvant chemotherapy for early-stage epithelial ovarian cancer: single or combination chemotherapy? BJOG 2010; 117:1459.
- du Bois A, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol 2005; 16 Suppl 8:viii7.
- Bell J, Brady MF, Young RC, et al. Randomized phase III trial of three versus six cycles of adjuvant carboplatin and paclitaxel in early stage epithelial ovarian carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2006; 102:432.
- Chan JK, Tian C, Fleming GF, et al. The potential benefit of 6 vs. 3 cycles of chemotherapy in subsets of women with early-stage high-risk epithelial ovarian cancer: an exploratory analysis of a Gynecologic Oncology Group study. Gynecol Oncol 2010; 116:301.
- Sugiyama T, Kamura T, Kigawa J, et al. Clinical characteristics of clear cell carcinoma of the ovary: a distinct histologic type with poor prognosis and resistance to platinum-based chemotherapy. Cancer 2000; 88:2584.
- Dizon DS, Restivo A, Lomme M, et al. For women receiving chemotherapy for clinically apparent early ovarian cancer, is there a benefit to surgical staging? Am J Clin Oncol 2008; 31:39.
- Le T, Adolph A, Krepart GV, et al. The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma. Gynecol Oncol 2002; 85:351.
- Mannel RS, Brady MF, Kohn EC, et al. A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol 2011; 122:89.
- SELECTION OF PATIENTS
- CHOICE OF ADJUVANT TREATMENT
- Intravenous chemotherapy
- SPECIAL CONSIDERATIONS
- Clear cell histology
- Unstaged patients
- Intraperitoneal chemotherapy
- Maintenance therapy
- POSTTREATMENT SURVEILLANCE
- TREATMENT OF RECURRENT DISEASE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS