title: Current approaches and challenges in managing and monitoring treatment response in ovarian cancer.
abstract: Epithelial ovarian cancer is the leading cause of death among gynecologic malignancies. Treatment of recurrent ovarian cancer remains a challenge despite advances in surgical and chemotherapeutic options. A goal of many providers is to detect recurrences as early as possible and initiate treatment though there is controversy as to whether this impacts outcome. Elevations in CA125 and radiological findings may precede symptoms of recurrence by several months. While detection of recurrences by physical exam alone is unusual, a thorough exam in conjunction with reported symptoms and elevated CA125 is sufficient to detect 80-90% of recurrences. A spiral CT scan may be used to confirm recurrence in the setting of asymptomatic CA125 elevation and a PET/CT can yield additional insight if the CT is inconclusive. Initiating chemotherapy prior to the development of symptoms, even in the setting of elevated CA125, does not impact overall survival primarily because the efficacy of available treatments in the recurrent setting is poor. More information about tumor biology and ways to predict which patients will benefit from available treatment options is required. Consequently, the approach to post-treatment surveillance should be individualized taking into account the clinical benefit of the second-line therapy, versus the costs and morbidity of the surveillance method.
authors.affiliation: 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Marcus
authors.affiliation: 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 3. Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA22042, USA.
authors.forename: G Larry
authors.initials: GL
authors.lastname: Maxwell
authors.affiliation: 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Darcy
authors.affiliation: 1. Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA 22003, USA ; 2. Gynecologic Oncology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Hamilton
authors.affiliation: 4. Department of Medicine, Inova Fairfax Hospital, Falls Church, VA 22042, USA.
authors.forename: William P
authors.initials: WP
authors.lastname: McGuire
keywords: Ovarian Cancer; Treatment Response