Epithelial carcinoma of the ovary: current strategies.

Epithelial ovarian cancer is usually diagnosed late in its biologic course (70% of cases are diagnosed as stage III or IV). Recent advances in chemotherapy and radiation therapy offer the possibility of long-term disease-free survival and the potential for cure. The selection of treatment for disease confined to the pelvis (stage I or II) remains controversial. After total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, high risk patients probably should receive abdominopelvic irradiation or chemotherapy; the relative roles of these two modalities are currently under study. Stage III consists of cases of minimal residual disease at surgery, minimal residual disease after debulking surgery, and residual large bulky tumor masses. Patients with minimal residual disease are best treated with either abdominopelvic radiation or chemotherapy; patients with stage IV or bulky stage III disease, with chemotherapy. Despite the multiplicity of active single agents, only one study to date has shown a statistically significant improvement in survival for patients with advanced disease utilizing combination chemotherapy.