[Epithelial ovarian cancer].
Ovarian cancer (OC) is associated with the highest cancer-related mortality among gynecological cancers, since nearly 2/3 of patients are diagnosed with advanced stage disease which is caused by an unspecific clinical appearance and the lack of effective early detection methods. So far only histopathological and clinical prognostic factors have clinical relevance from which FIGO-stage and the postoperative residual disease have predominant importance. Early stage OC (FIGO Ia-II) has a good prognosis with survival rates of approximately 90%, provided that the tumor is macroscopically resected and an adequate surgical staging has been performed. Additionally early stage OC patients should receive an adjuvant platinum-based chemotherapy. In advanced stage OC (FIGO IIb-IV) the aim of primary surgery is a maximum cytoreduction. Additionally, postoperative treatment is performed with carboplatin/paclitaxel for six cycles. So far there are no data to support the introduction of non-cross-resistant agents, dose escalation or prolongation of therapy. The majority of advanced stage patients relapse despite optimal primary therapy. Treatment of recurrent disease follows palliative considerations and should serve symptom control and tumor regression and especially quality of life. The prognosis of recurrent disease differs extensively according to the length of the progression-free survival and response to primary platinum-based chemotherapy and is differentiated into platinum-refractory and platinum-sensitive disease. Platinum-refractory OC generally have an extensive chemoresistance against all available cytostatic agents. Various mono-chemotherapies do not exceed response rates of 20%. In contrast, platinum-sensitive recurrent OC have a much more favourable prognosis due to response rates of 30-50% with platinum-based combination therapies. Another operation seems to be only reasonable in case of platinum-sensitive recurrent disease and if the tumor can be macroscopically resected with no residual tumor The aftercare in OC should focus on the detection of recurrent disease and the detection and therapy of maintained treatment related toxicities as well as psycho-oncological aspects.
Hilpert
F
F
Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel. fhilpert@email.uni-kiel.de
Krause
G
G
Venhoff
L
L
Kühnle
E
E
Schem
C
C
Maass
N
N
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000097:blood; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010053:Ovary / Q000473:pathology; D011182:Postoperative Care; D011379:Prognosis; D013997:Time Factors
D018394:CA-125 Antigen