Management of Recurrent or Persistent Ovarian Cancer

Approximately 70-80% of patients with epithelial ovarian cancer will relapse after first-line chemotherapy with a platinum and taxane-based combination. These patients require further treatment and they may benefit from local and/or systemic therapy. The prognosis is poor and the management of relapsed ovarian cancer remains a difficult problem open to research [National Cancer Institute (NCI), 2010]. Most patients with epithelial ovarian carcinoma receive postoperative chemotherapy, either as adjuvant treatment after complete removal of all visible disease or because of residual tumor. Evaluation after chemotherapy completion includes CA 125 and imaging with chestX-Ray or CT scanning of the chest and CT scanning or MRI of the abdomen. The limitations of this evaluation are well known. In the past several institutions practiced a “second-look laparotomy”, which several times revealed widespread intra-abdominal disease in patients with a negative metastatic work-up. Early detection of persistent disease by second-look laparotomies after completing first-line treatment is no longer practiced, as it had no effect on patients’ outcome. The time to first relapse varies from a few months to several years (NCI, 2010). The median interval to first recurrence is 18 to 24 months. Half of the recurrences occur more than 12 months from the end of the first-line therapy, and one quarter of all recurrences occur at less than 6 months. Regarding recurrent sites at first relapse, the primary disease site is involved in fifty-five percent of the patients. Recurrence can also been noted in retroperitoneal or distant nodes, liver, spleen, brain, and bones. In order to clarify prognostic factors and to determine the best treatment approach grouping of recurrent patients has been applied. The results are not clear yet and more publications are needed. (Martin 2009; NCI 2011; Ushijima, 2010).