Can patients with relapsed, previously untreated, stage I epithelial ovarian cancer be successfully treated with salvage therapy?
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.
Kolomainen
Desiree F
DF
Gynaecology Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
A'Hern
Roger
R
Coxon
Fareeda Y
FY
Fisher
Cyril
C
King
D Michael
DM
Blake
Peter R
PR
Barton
Desmond P J
DP
Shepherd
John H
JH
Kaye
Stanley B
SB
Gore
Martin E
ME
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
D009944:Organoplatinum Compounds