In the absence of extra-abdominal metastatic disease, definitive staging of ovarian cancer requires laparotomy. The role of surgery in patients with stage IV disease and extra-abdominal disease is yet to be established. If disease appears to be limited to the ovaries or pelvis, it is essential at laparotomy to examine and biopsy or to obtain cytologic brushings of the diaphragm, both paracolic gutters, the pelvic peritoneum, para-aortic and pelvic nodes, and infracolic omentum, and to obtain peritoneal...
Updated statistics with estimated new cancer cases and deaths for 2011 (cited American Cancer Society as reference 1).
Stage Information for Ovarian Epithelial Cancer
Updated staging information for 2010 (cited Edge et al. as reference 8 and FIGO Committee on Gynecologic Oncology as reference 9).
Added Table 5 on carcinoma of the ovary (adapted from FIGO Committee on Gynecologic Oncology as reference 9).
Stage III and IV Ovarian Epithelial Cancer Treatment
Added text about a study led by the European Organization for the Research and Treatment of Cancer Gynecological Cancer Group and the National Cancer Institute of Canada Clinical Trials Group that included 670 women with stage IIIC and IV ovarian, tubal, and primary peritoneal cancers who were randomly assigned to primary debulking surgery followed by at least six courses of platinum-based chemotherapy or to three courses of neoadjuvant platinum-based chemotherapy followed by so-called interval debulking surgery, and at least three more courses of platinum-based chemotherapy. The primary endpoint of the study was overall survival (OS) with primary debulking surgery considered the standard (cited Vergote et al. as reference 5).
Added text to state that the median OS for the primary debulking surgery was 29 months, compared with 30 months for patients assigned to neoadjuvant chemotherapy; the hazard ratio for death in the group assigned to neoadjuvant chemotherapy followed by interval debulking, as compared with the group assigned to primary debulking surgery followed by chemotherapy, was 0.98 (cited Vergote et al. as reference 5 and level of evidence 1iiA). Also added that the perioperative and postoperative morbidity and mortality were higher in the primary-surgery group, and the strongest independent predictor of prolonged survival was the absence of residual tumor after surgery. Additionally added that the subset of patients achieving optimal cytoreduction whether after primary debulking surgery or after neoadjuvant chemotherapy followed by interval debulking surgery had the best median OS.
Added text to the list of findings demonstrated by clinical trials since the adoption of the platinum-plus-taxane combination as the standard to include noninferiority for carboplatin plus paclitaxel versus sequential carboplatin-containing doublets with either gemcitabine or topotecan; or, triplets with the addition of gemcitabine or pegylated liposomal doxorubicin to the reference doublet (cited Bookman et al. and Hoskins as references 25 and 26).
Added text about the Gynecologic Cancer InterGroup trial (GOG-0182) that randomly assigned 4,312 women with stage III or IV epithelial ovarian or primary peritoneal cancer to four different experimental arms and to a reference treatment consisting of carboplatin and paclitaxel every 3 weeks for eight cycles (cited Bookman et al. as reference 25).