Serum CA-125 as a guideline for the timing of a second-look operation and second-line treatment in ovarian cancer.

In the assessment of response to treatment of ovarian cancer patients, clinical examination is unreliable in detecting small tumor masses. The second-look laparotomy is therefore an accepted procedure. The optimal timing of second-look laparotomy, however, is uncertain. We therefore examined the usefulness of serial serum CA-125 estimations in the timing of second-look laparotomies in 33 patients suffering from ovarian cancer. Increasing CA-125 concentrations were always followed by relapses or progressive disease, whereas decreasing serum concentrations indicated response to treatment. In future we propose to perform second-look laparotomies when CA-125 levels have declined to a steady plateau and to start a secondary treatment when CA-125 levels start to rise again.