The stage of ovarian cancer is an important prognostic factor that influences survival and the choice of therapy. The quality of the surgical staging is a key determinant of treatment recommendations. Women who have undergone optimal surgical staging, including pelvic and para-aortic lymph node sampling, and have stage I disease may or may not benefit from adjuvant platinum-based chemotherapy. The results of the largest trial comparing adjuvant chemotherapy to no chemotherapy in women with early stage ovarian cancer (International Collaborative Ovarian Neoplasm Study/Adjuvant ChemoTherapy In Ovarian Neoplasm [ICON/ACTION] Trial) are controversial because:
A subgroup analysis of the ACTION Trial showed no benefit from adjuvant chemotherapy in women who underwent optimal surgical staging, but that analysis was underpowered.
The entry criteria for the ICON Trial were vague and did not reflect the standard of surgical care generally offered. The meta-analysis demonstrates that stage I patients have an improved outcome with adjuvant chemotherapy. However, an estimated 90% of women undergoing surgical resection for ovarian cancer do not undergo optimal surgical staging. If the restaging of a suboptimally staged patient reveals a more advanced disease, chemotherapy is the preferred treatment option. If reoperation confirms stage I disease, there is insufficient evidence for or against adjuvant chemotherapy. However,
NCCN lists adjuvant chemotherapy or observation alone as an option for stage Ia ovarian cancer. The most established regimen is Taxol and carboplatin.
Gynecology Cancer Disease Site Group. Elit L, Fyles A, Chambers A, Fung Kee Fung M, Covens A, Carey M. Adjuvant care for stage I ovarian cancer [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2004 May 3. 33 p. (Practice guideline report; no. 4-13). [62 references]