Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints

In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.

Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma

To investigate the development regularity, treatment methods and prognosis of ovary immature teratoma (POIT) Methods Sixty seven patients with POIT, admitted from 1958 to 1998, were retrospectively analyzed There were 31 patients with stage Ⅰ, 4 with stage Ⅱ, 2 with stage Ⅲ and 1 with stage Ⅳ lesions Twenty seven patients had recurrences and 2 had distant metastases Unilateral adnexectomy was performed for stage Ⅰ lesions From the 1980s, this was followed by four cycles of combination chemotherapy (VAC, PVB or BEP×3 cycles) as post operative adjuvant therapy Combined chemotherapy and multiple operations were performed for advanced and recurrent lesions Results The overall survival rate was 75% (50/67) However, there was a remarkable difference in the results from the various periods From 1958 to 1983, the 5 year survival rate was 40% (6/15), and it was raised to 79% (26/33) from 1984 to 1993 In the period 1994 to 1998, 95% (18/19)of patients were rescued Thirty five patients who had early lesions (stage Ⅰ and Ⅱ) had a 5 year survival rate of 91 4% (32/35) Thirty two patients with recurrent or advanced lesions had a 5 years survival rate of 56% (18/32) There were 8 patients with grade Ⅲ tumors and their 5 year survival rate was only 25% (2/8) The chief prognostic factors for this disease are clinical stage, pathological grade and adequate treatment Conclusion POIT is a potentially curable disease in today’s practice It is characterized by the fact that recurrent tumors may be converted back to mature ones as time goes on With chemotherapy, these is a good opportunity to rescue those patients with recurrent tumors At present, treatment of POIT gives the most satisfactory results among all malignant ovarian germ cell tumor types Tests of serum specific tumor markers (CA19 9, AFP, CA125, CEA) performed preoperatively or before chemotherapy and during follow up have been found helpful in the evaluation of prognosis