title: Can patients with relapsed, previously untreated, stage I epithelial ovarian cancer be successfully treated with salvage therapy?
abstract: OBJECTIVE
  The role of adjuvant chemotherapy in early-stage epithelial ovarian cancer (EOC) has been controversial. We have previously reported the cases of patients managed with a policy of observation only. We now present the salvage rate for the patients in that study who experienced relapse.
  
  
  METHODS
  One hundred ninety-four patients with stage I EOC presenting between 1980 and 1994 received no adjuvant chemotherapy, but were treated with platinum-based chemotherapy at relapse. We calculated the progression-free survival (PFS) and overall survival (OS) for the whole cohort and the salvage rate for those who experienced relapse. We defined salvage as freedom from relapse for 5 years after platinum treatment.
  
  
  RESULTS
  Sixty-one (31%) of 194 patients experienced relapse, and 55 received platinum-based chemotherapy. Twenty-four percent were progression-free at 5 years after this treatment. Clear-cell histology and cyst rupture before the patients' original surgery were independent prognostic factors for PFS after salvage chemotherapy. The OS for all 194 patients is 72% at 10 years (median follow-up, 8.7 years), with an 80% disease-specific survival (DSS).
  
  
  CONCLUSIONS
  We have shown that some patients with stage I EOC can be successfully treated with a salvage chemotherapy regimen after a policy of observation only. Interestingly, approximately 30% of stage I patients who die within 10 years do so from causes other than EOC (OS, 72%; DSS, 80%). Our findings need to be taken into consideration when the results from recent randomized trials of adjuvant chemotherapy in this patient population (International Collaborative Ovarian Neoplasm Trial 1/European Organization for Research and Treatment of Cancer Adjuvant Chemotherapy in Ovarian Neoplasm Trial) are being discussed with patients.
authors.affiliation: Gynaecology Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
authors.forename: Desiree F
authors.initials: DF
authors.lastname: Kolomainen
authors.forename: Roger
authors.initials: R
authors.lastname: A'Hern
authors.forename: Fareeda Y
authors.initials: FY
authors.lastname: Coxon
authors.forename: Cyril
authors.initials: C
authors.lastname: Fisher
authors.forename: D Michael
authors.initials: DM
authors.lastname: King
authors.forename: Peter R
authors.initials: PR
authors.lastname: Blake
authors.forename: Desmond P J
authors.initials: DP
authors.lastname: Barton
authors.forename: John H
authors.initials: JH
authors.lastname: Shepherd
authors.forename: Stanley B
authors.initials: SB
authors.lastname: Kaye
authors.forename: Martin E
authors.initials: ME
authors.lastname: Gore
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000628:therapy*; D011379:Prognosis; D016879:Salvage Therapy; D016019:Survival Analysis
chemical_list: D009944:Organoplatinum Compounds