[Primary treatment of ovarian cancer].
BACKGROUND
Patients with epithelial ovarian cancer are often diagnosed with advanced disease; hence they have a generally poor survival rate. The main objective was to assess the clinical effectiveness of the four main treatment options in the primary treatment of epithelial ovarian cancer: i) adjuvant chemotherapy and/or adjuvant radiotherapy, ii) cytoreductive surgery, iii) neoadjuvant chemotherapy in advanced disease, and iv) postoperative chemotherapy in advanced disease.


METHODS
The scientific literature was identified by searches in Medline, Embase and Cochrane CCTR and by additional manual searches. Using criteria defined by protocol, two reviewers assessed each study according to relevance, quality and validity. Among 2227 publications identified, 635 were read as full-text articles, and 90 studies were critically assessed as relevant publications. All included studies were systematised in three subgroups according to the quality of the study design in question and the validity of the results: high, moderate, or low. A total of 45 studies of high or moderate quality form the documentary basis for this review.


RESULTS
Current data are inconclusive regarding the effect of adjuvant chemotherapy. Retrospective data show a survival advantage for patients who have had maximum cytoreductive surgery. The effect of neoadjuvant chemotherapy is uncertain. Several questions remain unanswered despite wide acceptance of paclitaxel-carboplatin as the current standard in first-line treatment.


CONCLUSIONS
This systematic review demonstrates the need for more clinical studies.
Lyngstadaas
Anita
A
Senter for medisinsk metodevurdering (SMM), SINTEF Helse, Postboks 124 Blindern, 0314 Oslo. anita.Lyngstadaas@kunnskapssenteret.no
Ekanger
Roald
R
Hagen
Bjørn
B
Himmelmann
Anna
A
Iversen
Ole Erik
OE
Iversen
Torbjørn
T
Nordal
Randi
R
Norheim
Ole Frithjof
OF
Onsrud
Mathias
M
Tretli
Steinar
S
Tropé
Claes
C
D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
D000970:Antineoplastic Agents