Early Ovarian Cancer

Question 0

Do u perform appy?

Answer 0

Affected 8% in mucinous

Question 1

What is the effect of intraop rupture?

Answer 1

Vergote 2001 meta analysis looked at stage I disease. Degree if diff, preop and intraop rupture most powerful indicators for disease free survival. 5 yr survival : no rupture 83%, preop rupture 72%, intraop rupture 70%

Question 2

And who do you offer fertility preservation?

Answer 2

Stage 1A and 1C, but not stage IB invasive ovarian ca with good risk factors, All ovarian Lmp tumors, germ cell, SCST. Staging should be done to rule out occult higher stage EXCEPT for pediatric germ cell

Question 3

What is the percentage of patients with stage I disease could get upstaged?

Answer 3

30%

Question 4

And who do you offer chemotherapy to?

Answer 4

Everybody greater than a stage 1a or 1B, grade one ( survival is greater than 90%) and possibly grade 2.

Question 5

Icon/action trial for stage I? Do you need chemo for stage I ovarian ca?

Answer 5

Statistically significant survival benefit for chemotherapy. However, there was a high rate of unstaged patients. When they did look at fully staged patients there was no benefit.

Question 6

How many cycles do you offer early Ovarian cancer patients?

Answer 6

GOG 157: stage IA,B G3/ stage IC or II any grade randomized 3 vs 6 cycles:
No significant overall survival benefit or difference in recurrence rate. ACTION and ICON 1 showed chemo had better OS than obs but staging was not mandated. When subset looked at those staged: complete staging did not benefit from chemo.

Question 7

Any role for maintenance therapy and early ovarian cancer?

Answer 7

To achieve 175 randomize taxol low dose versus observation showed no difference

Question 8

Is there any role for 3 vs 6 cycles in early ovarian ca individualized for histology?

Answer 8

5-year recurrence-free survival was 83% and 60% in those who received six vs. three cycles of chemotherapy, respectively. Chan 2010