Extent of disease is ascertained by a surgical procedure that permits visual and manual inspection of all peritoneal surfaces and the diaphragm. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, pelvic and paraaortic lymph node sampling, and peritoneal washings should be performed. The staging system and its influence on survival are shown in Table 73-1. About 23% of pts are stage I, 13% are stage II, 47% are stage III, and 16% are stage IV.
Treatment: Ovarian Cancer Pts with stage I disease, no residual tumor after surgery, and well- or moderately differentiated tumors need no further treatment after surgery and have a 5-year survival of >95%. For stage II pts totally resected and stage I pts with poor histologic grade, adjuvant therapy with single-agent cisplatin or cisplatin plus paclitaxel produces 5-year survival of 80%. In the setting of bulky disease, maximal surgical cytoreduction is attempted. Those in whom no gross residual disease is left have a median survival of 39 months; those left with visible tumor, 17 months. Giving chemotherapy before definitive surgery (neoadjuvant) may increase the fraction of pts whose gross disease is resectable. Advanced-stage pts should receive paclitaxel, 175 mg/m2 by 3-h infusion, followed by carboplatin dosed to an area under the curve (AUC) of 6 every 3 or 4 weeks. Carboplatin dose is calculated by the Calvert formula: dose = target AUC × (glomerular filtration rate + 25). Some data support intraperitoneal delivery of the chemotherapy. The complete response rate is about 55%, and median survival is 38 months. |
Section 6. Hematology and Oncology