title: [Primary treatment of ovarian cancer].
abstract: 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.
authors.affiliation: Senter for medisinsk metodevurdering (SMM), SINTEF Helse, Postboks 124 Blindern, 0314 Oslo. anita.Lyngstadaas@kunnskapssenteret.no
authors.forename: Anita
authors.initials: A
authors.lastname: Lyngstadaas
authors.forename: Roald
authors.initials: R
authors.lastname: Ekanger
authors.forename: Bjørn
authors.initials: B
authors.lastname: Hagen
authors.forename: Anna
authors.initials: A
authors.lastname: Himmelmann
authors.forename: Ole Erik
authors.initials: OE
authors.lastname: Iversen
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Iversen
authors.forename: Randi
authors.initials: R
authors.lastname: Nordal
authors.forename: Ole Frithjof
authors.initials: OF
authors.lastname: Norheim
authors.forename: Mathias
authors.initials: M
authors.lastname: Onsrud
authors.forename: Steinar
authors.initials: S
authors.lastname: Tretli
authors.forename: Claes
authors.initials: C
authors.lastname: Tropé
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents