title: Risk factors for ovarian cancer: a case-control study. Treatment of ovarian germ cell tumors with a 3-day bleomycin, etoposide, and cisplatin regimen: a prospective multicenter study. Surgery as sole treatment for serous borderline tumors of the ovary with noninvasive implants. Pegylated liposomal Doxorubicin and Carboplatin compared with Paclitaxel and Carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. Laparoscopic fertility-sparing staging in unexpected early stage ovarian malignancies. Salvage surgery for chemorefractory ovarian germ cell tumors. Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chicago, and Princess Margaret Hospital phase II consortia. Comparison of two fertility-sparing approaches for bilateral borderline ovarian tumours: a randomized controlled study. Optimal chemotherapy treatment for women with recurrent ovarian cancer Protracted oral etoposide in epithelial ovarian cancer: a phase II study in patients with relapsed or platinum-resistant disease. Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. Impact of second look laparotomy and secondary cytoreductive surgery at second‐look laparotomy in ovarian cancer patients Ultrasound, physical examination, and CA 125 measurement for the detection of recurrence after conservative surgery for early borderline ovarian tumors. International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. Combination therapy with gemcitabine and carboplatin in recurrent ovarian cancer Dose-dense paclitaxel once a week in combination with carboplatin every 3 weeks for advanced ovarian cancer: a phase 3, open-label, randomised controlled trial Secondary cytoreduction plus oxaliplatin-based HIPEC in platinum-sensitive recurrent ovarian cancer patients: a pilot study. Nonplatinum topotecan combinations versus topotecan alone for recurrent ovarian cancer: results of a phase III study of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group. Phase II trial of gemcitabine in refractory germ cell tumors. Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer Randomized study of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group comparing quality of life in patients with ovarian cancer treated with cisplatin/paclitaxel versus carboplatin/paclitaxel. An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-OV28) in assessing the quality of life of patients with ovarian cancer. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a gynecologic oncology group study. Parity, contraception, infertility, and the risk of epithelial ovarian cancer. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Effective palliative radiation therapy in advanced and recurrent ovarian carcinoma. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Implications of second-look laparotomy in the context of optimally resected stage III ovarian cancer: a non-randomized comparison using an explanatory analysis: a Gynecologic Oncology Group study. Pure Ovarian Immature Teratoma, a Unique and Curable Disease: 10 Years' Experience of 32 Prospectively Treated Patients Clinical evidence for topotecan-paclitaxel non--cross-resistance in ovarian cancer. OCEANS: A randomized, double-blinded, placebo-controlled phase III trial of chemotherapy with or without bevacizumab (BEV) in patients with platinum-sensitive recurrent epithelial ovarian (EOC), primary peritoneal (PPC), or fallopian tube cancer (FTC).
abstract: A hospital-based case-control study of ovarian cancer was conducted in London and Oxford between October 1978 and February 1983 .  Menstrual characteristics , reproductive and contraceptive history and history of exposure to various environmental factors were compared between 235 women with histologically diagnosed epithelial ovarian cancer and 451 controls . High gravidity , hysterectomy , female sterilisation and oral contraceptive use were associated with a reduced risk of ovarian cancer . Infertility and late age at menopause were associated with an increase in risk . While these factors were related , they were each found to be independently associated with ovarian cancer risk after adjusting for the effect of the other factors BACKGROUND Ovarian germ cell tumors ( OGCT ) are highly curable when treated with cytoreductive surgery and platinum-based chemotherapy . We evaluated the safety and activity of a 3-day modified bleomycin , etoposide , and cisplatinum ( mBEP ) regimen in patients with OGCT . PATIENTS AND METHODS Patients with FIGO stages I-IV OGCT were treated with three ( stages I-III complete resection ) or four cycles ( incomplete resection or stage IV ) of bleomycin 15 mg iv , etoposide 120 mg/m(2 ) iv , and cisplatin 40 mg/m(2 ) iv for 3 days every 3 weeks . RESULTS Forty-eight patients ( 14 with dysgerminoma and 34 with non-dysgerminomatous tumors ) were included in our study . Most patients had stage I disease ( 65 % ) and complete resection of their tumor ( 67 % ) . Twenty percent of patients developed grade 3 or 4 neutropenia with 4 episodes of neutropenic fever . During follow-up ( median : 5 years ) , two patients developed progressive disease including one patient who died . All patients with stage I or II disease and all patients with dysgerminoma remain free of disease . However , 20 % of patients with non-dysgerminomatous tumors stage III or IV experienced progressive disease . CONCLUSION The modified 3-day BEP regimen was safe and effective in patients with OGCT . Further improvements are needed for patients with advanced , suboptimally debulked non-dysgerminomatous tumors OBJECTIVES The objectives were to describe the clinical characteristics and prognosis of surgically treated patients with stage II and III serous borderline tumors of the ovary with noninvasive implants .  MATERIAL S AND METHODS From 1990 to 2000 , 16 patients with stage II and III ovarian serous borderline tumors and noninvasive implants  were diagnosed and prospect ively followed at our center . All patients underwent surgical treatment including staging and their pathology was review ed . Fifteen patients had thorough surgical staging by laparotomy , while one patient was staged laparoscopically . No patient was treated with adjuvant therapy ( radiation or chemotherapy ) after surgical treatment and none were lost to follow-up . RESULTS The mean age at diagnosis was 42 years ( range 26 - 59 ) . Fourteen patients were treated by abdominal hysterectomy , bilateral salpingo-oophorectomy , omentectomy , and multiple peritoneal biopsies  , while 2 patients were treated conservatively for fertility preservation . Two patients underwent pelvic and para-aortic lymph node dissection . Fifteen of 16 patients had ovarian surface involvement with tumor . All patients but 2 had clinical evidence of extraovarian disease at the time of surgery . The mean duration of follow-up was 60.7 months ( range 2 - 134 months ) . Thirteen patients ( 81 % ) are alive without evidence of disease . Four patients ( 25 % ) required subsequent surgery for recurrent disease and all are still alive . Two patients have been treated with chemotherapy ( paclitaxel/carboplatin ) for progressive borderline disease , while an additional patient was treated after first relapse with chemotherapy for an invasive recurrence . CONCLUSIONS Carefully staged patients with advanced serous borderline tumors of the ovary and noninvasive implants have a good prognosis without adjuvant therapy PURPOSE This r and omized , multicenter , phase III noninferiority trial was design ed to test the efficacy and safety of the combination of pegylated liposomal doxorubicin ( PLD ) with carboplatin ( CD ) compared with st and ard carboplatin and paclitaxel ( CP ) in patients with platinum-sensitive relapsed/recurrent ovarian cancer ( ROC ) . PATIENTS AND METHODS Patients with histologically proven ovarian cancer with recurrence more than 6 months after first- or second-line platinum and taxane-based therapies were r and omly assigned by stratified blocks to CD ( carboplatin area under the curve [ AUC ] 5 plus PLD 30 mg/m(2 ) ) every 4 weeks or CP ( carboplatin AUC 5 plus paclitaxel 175 mg/m(2 ) ) every 3 weeks for at least 6 cycles . Primary end point was progression-free survival ( PFS ) ; secondary end points were toxicity , quality of life , and overall survival . RESULTS Overall 976 patients were recruited . With median follow-up of 22 months , PFS for the CD arm was statistically superior to the CP arm ( hazard ratio , 0.821 ; 95 % CI , 0.72 to 0.94 ; P = .005 ) ; median PFS was 11.3 versus 9.4 months , respectively . Although overall survival data are immature for final analysis , we report here a total of 334 deaths . Overall severe nonhematologic toxicity ( 36.8 % v 28.4 % ; P < .01 ) leading to early discontinuation ( 15 % v 6 % ; P < .001 ) occurred more frequently in the CP arm . More frequent grade 2 or greater alopecia ( 83.6 % v 7 % ) , hypersensitivity reactions ( 18.8 % v 5.6 % ) , and sensory neuropathy ( 26.9 % v 4.9 % ) were observed in the CP arm ; more h and -foot syndrome ( grade 2 to 3 , 12.0 % v 2.2 % ) , nausea ( 35.2 % v 24.2 % ) , and mucositis ( grade 2 - 3 , 13.9 % v 7 % ) in the CD arm . CONCLUSION To our knowledge , this trial is the largest in recurrent ovarian cancer and has demonstrated superiority in PFS and better therapeutic index of CD over st and ard CP OBJECTIVE To assess feasibility and safety of fertility-sparing laparoscopic staging in women affected by unexpected ovarian cancer desiring to preserve their fertility . DESIGN Prospect i ve study . SETTING University clinic . PATIENT(S ) Twenty-seven patients already operated on elsewhere for a presumably benign ovarian cyst . INTERVENTION(S ) Laparoscopic fertility-sparing staging operations . MAIN OUTCOME MEASURE(S ) Perioperative and survival data , reproductive outcome . RESULT ( S ) Histologic findings after first surgery : 12 low malignant potential neoplasms , 11 invasive epithelial ovarian carcinomas,1 sex-cord stromal , and 3 germ cell neoplasms . Fertility-sparing staging consisted of exploration of the peritoneal cavity , peritoneal washing cytology , multiple peritoneal biopsies , omolateral adnexectomy ( except in borderline tumors ) , omentectomy , omolateral or bilateral pelvic and aortic lymph node sampling ( except in borderline tumors , well differentiated , mucinous , and granulosa cell ( GC ) neoplasms ) , endometrial biopsy , appendectomy in mucinous type . Overall , seven patients ( 26 % ) were upstaged . Six patients received adjuvant platinum-based chemotherapy . Two term pregnancies occurred . After a median follow-up of 20 months all patients are alive ; one patient has FIGO stage Ic clear cell carcinoma , which recurred 8 months after surgery . CONCLUSION ( S ) Laparoscopic fertility-sparing staging in early ovarian malignancies is feasible and safe in selected and counseled patients and should be performed in experienced gynecological oncology centers trained in endoscopic procedures This study was undertaken to determine whether secondary surgical debulking is beneficial for patients with malignant ovarian germ cell tumors ( OGCT ) . Twenty patients with OGCT treated at our institution between 1975 and 1992 were retrospectively identified and analyzed . Survival was analyzed using the life-table methods of Kaplan and Meier and the statistical significance of various perioperative factors was tested by both the log-rank and the Wilcoxon tests . Histologic tumor type included 8 immature teratomas , 6 mixed tumors , 5 endodermal sinus tumors , and 1 dysgerminoma . After primary surgery , all patients received chemotherapy -- non-platinum-based in 12 patients , platinum-based in 5 , and both types in 3 patients . Treatment failure was classified as progression in 14 patients , persistence in 3 , and recurrence in 3 . Salvage surgery consisted of exploratory laparotomy and tumor debulking in 18 patients , inguinal lymphadenectomy in 1 , and thoracotomy and wedge resection in 1 . Sixteen patients subsequently received salvage chemotherapy . At the time of analysis , 11 patients were alive disease-free , 1 was alive with tumor , 6 had died of tumor progression , and 2 had died of treatment-related complications . Survival of patients with immature teratoma who underwent salvage surgery was significantly better than survival of those with other tumor cell types ( P = 0.006 ) . In conclusion , although the role of secondary debulking in chemorefractory OGCT remains undetermined , it may have some benefit for a select group of patients , particularly those with immature teratoma PURPOSE To determine the side effects and feasibility of cisplatin and carboplatin each in combination with paclitaxel as front-line therapy in advanced epithelial ovarian cancer . PATIENTS AND METHODS Patients were r and omly allocated to receive paclitaxel 175 mg/m(2 ) intravenously as a 3-hour infusion followed by either cisplatin 75 mg/m(2 ) or carboplatin ( area under the plasma concentration-time curve of 5 ) , both on day 1 . The schedule was repeated every 3 weeks for at least six cycles . Women allocated to paclitaxel-cisplatin were admitted to the hospital , whereas the carboplatin regimen was administered to out patients . RESULTS A total of 208 eligible patients were r and omized . Both regimens could be delivered in an optimal dose and without significant delay . Paclitaxel-carboplatin produced significantly less nausea and vomiting ( P : < .01 ) and less peripheral neurotoxicity ( P : = .04 ) but more granulocytopenia and thrombocytopenia ( P : < .01 ) . The overall response rate in 132 patients with measurable disease was 64 % ( 84 of 132 patients ) , and in patients with elevated CA 125 levels at start , it was 74 % ( 132 of 178 patients ) . With a median follow-up time of 37 months , the median progression-free survival time of all patients was 16 months and the median overall survival time was 31 months . The small number of patients entered onto the study caused wide confidence intervals ( CIs ) around the hazards ratio for progression-free survival of paclitaxel-carboplatin compared with paclitaxel-cisplatin ( hazards ratio , 1.07 ; 95 % CI , 0.78 to 1.48 ) and did not allow conclusions about efficacy . CONCLUSION Paclitaxel-carboplatin is a feasible regimen for out patients with ovarian cancer and has a better toxicity profile than paclitaxel-cisplatin PURPOSE Vascular endothelial growth factor ( VEGF ) plays an important role in the biology of ovarian cancer ( OC ) . Inhibitors of VEGF suppress tumor growth in OC models . Metronomic chemotherapy , defined as frequent administration of low doses of cytotoxic chemotherapy , suppresses tumor growth , possibly by inhibiting angiogenesis . A phase II trial was conducted to evaluate the antitumor activity and adverse effects of bevacizumab and metronomic oral cyclophosphamide in women with recurrent OC . PATIENTS AND METHODS Patients with measurable disease and prior treatment with a platinum-containing regimen were eligible . Up to two different regimens for recurrent disease were allowed . Treatment consisted of bevacizumab 10 mg/kg intravenously every 2 weeks and oral cyclophosphamide 50 mg/d . The primary end point was progression-free survival at 6 months . Plasma levels of VEGF , E-selectin , and thrombospondin-1 were obtained serially . RESULTS Seventy patients were enrolled . The probability of being alive and progression free at 6 months was 56 % ( + /- 6 % SE ) . A partial response was achieved in 17 patients ( 24 % ) . Median time to progression and survival were 7.2 and 16.9 months , respectively . The most common serious toxicities were hypertension , fatigue , and pain . Bevacizumab-related toxicities included four episodes of gastrointestinal perforation or fistula , two episodes each of CNS ischemia and pulmonary hypertension , and one episode each of gastrointestinal bleeding and wound healing complication . There were three treatment-related deaths . Levels of VEGF , E-selectin , and thrombospondin-1 were not associated with clinical outcome . CONCLUSION The combination of bevacizumab and metronomic cyclophosphamide is active in recurrent OC . Further study of this combination is warranted BACKGROUND During the childbearing years , the st and ard fertility-sparing treatment for bilateral borderline ovarian tumours ( BOTs ) is the unilateral oophorectomy plus controlateral cystectomy . The aim of the present study was to compare the effects of two laparoscopic fertility-sparing surgical procedures for the treatment of bilateral BOTs on recurrence and fertility in young women who desire to conceive as soon as possible . METHODS Thirty-two women affected by bilateral early-stage BOTs who desired to conceive were r and omized to receive bilateral cystectomy ( experimental group , n=15 ) or oophorectomy plus controlateral cystectomy ( control group , n=17 ) . At the first recurrence after childbearing completion , each patient was treated with non-conservative st and ard treatment . Recurrences and reproductive events were recorded . RESULTS After a follow-up period of 81 months ( 19 inter-quartile ; 60 - 96 range ) , the cumulative pregnancy rate ( CPR ) ( 14/15 versus 9/17 ; P=0.003 ) and the cumulative probability of first pregnancy ( P= 0.011 ) were significantly higher in the experimental than in control group . No significant ( P=0.358 ) difference between groups was detected in cumulative probability of first recurrence . CONCLUSIONS The laparoscopic bilateral cystectomy followed by non-conservative treatment performed at the first recurrence after the childbearing completion is an effective surgical strategy for patients with bilateral early-stage BOTs who desire to conceive as soon as possible Question What is the optimal chemotherapy treatment for women with recurrent ovarian cancer who have previously received platinum-based chemotherapy  ? Perspectives Currently , st and ard primary therapy for advanced disease involves a combination of maximal cytoreductive surgery and chemotherapy with carboplatin plus paclitaxel or with carboplatin alone . Despite initial high response rates , a large proportion of patients relapse , result ing in a therapeutic challenge . Because these patients are not curable , the goal of therapy becomes improvement in both quality and length of life . The search has therefore been to find active agents for women with recurrent disease following platinum-based chemotherapy .  Outcomes Outcomes of interest included any combination of tumour response rate , progression-free survival , overall survival , adverse events , and quality of life . Methodology The medline , embase , and Cochrane Library data bases were systematic ally search ed for primary articles and practice guidelines . The result ing evidence informed the development of clinical practice recommendations . The systematic review and recommendations were approved by the Report Approval Panel of the Program in Evidence -Based Care , and by the Gynecology Cancer Disease Site Group ( dsg ) . The practice guideline was externally review ed by a sample of practitioners from Ontario , Canada . Results Thirteen r and omized trials compared various chemotherapy regimens for patients with recurrent ovarian cancer . In five of the thirteen trials in which 100 % of patients were considered sensitive to platinum-containing chemotherapy , further platinum-based combination chemotherapy significantly improved response rates ( two trials ) , progression-free survival ( four trials ) , and overall survival ( three trials ) when compared with single-agent chemotherapy involving carboplatin or paclitaxel . Only two of these r and omized trials compared the same chemotherapy regimens : carboplatin alone versus the combination of carboplatin and paclitaxel . Both trials were consistent in reporting improved survival outcomes with the combination of carboplatin and paclitaxel . In one trial , the combination of carboplatin and gemcitabine result ed in significantly higher response rates and improved progression-free survival when compared with carboplatin alone . Median survival with carboplatin alone ranged from 17 months to 24 months in four trials . In eight of the thirteen trials in which 35%–100 % of patients had platinum-refractory or -resistant disease , one trial reported a statistically significant 2-month improvement in overall survival with liposomal doxorubicin as compared with topotecan ( 15 months vs. 13 months , p = 0.038 ; hazard ratio : 1.23 ; 95 % confidence interval : 1.01 to 1.50 ) . In that trial , because of the limited clinical benefit and the unusual finding that a survival difference emerged only after a year of treatment with no corresponding improvement in the rate of response or of progression-free survival , the authors concluded that further confirmation by results from r and omized trials were needed to establish the superiority of one agent over another in their trial . In one trial , topotecan was superior to treosulphan in patient progression-free survival by a span of approximately 2 months ( 5.4 months vs. 3.0 months , p < 0.001 ) . Toxicity was reported in all of the r and omized trials , and although data on adverse events varied by treatment regimen , the observed adverse events correlated with known toxicity profiles . As expected , combination chemotherapy was associated with higher rates of adverse events . Practice Guideline Target Population This clinical recommendation applies to women with recurrent epithelial ovarian cancer who have previously received platinum-based chemotherapy .  Of specific interest are women who have previously shown sensitivity to platinum therapy and those who previously were refractory or resistant to platinum-based chemotherapy . As a general categorization within what is actually a continuum , “ platinum sensitivity ” refers to disease recurrence 6 months or more after prior platinum-containing chemotherapy , and “ platinum resistance ” refers to a response to platinum-based chemotherapy followed by relapse less than 6 months after chemotherapy is stopped . “ Platinum-refractory disease ” refers to a lack of response or to progression while on platinum-based chemotherapy . Recommendations Although the body of evidence that informs the clinical recommendations is based on r and omized trial data , those data are incomplete . Based on the available data and expert consensus opinion , the Gynecology Cancer dsg makes these recommendations : Systemic therapy for recurrent ovarian cancer is not curative . It is therefore recognized that each patient must be individually assessed to determine optimal therapy in terms of recurrence , sensitivity to platinum , toxicity , ease of administration , and patient preference . All suitable patients should be offered the opportunity to participate in r and omized trials , if available . In the absence of contraindications , combination platinum-based chemotherapy should be considered for patients with prior sensitivity to platinum-containing chemotherapy . As compared with carboplatin alone , the combination of carboplatin and paclitaxel significantly improved both progression-free and overall survival . If combination platinum-based chemotherapy is not indicated , then a single platinum agent should be considered . Carboplatin has demonstrated efficacy across trials and has a manageable toxicity profile . If a single platinum agent is not being considered , then monotherapy with paclitaxel , topotecan , or pegylated liposomal doxorubicin are seen as reasonable treatment options . Some patients may be repeatedly sensitive to treatment and may benefit from multiple lines of chemotherapy . For patients with platinum-refractory or platinum-resistant disease , the goals of treatment should be to improve quality of life by extending the symptom-free interval , by reducing symptom intensity , and by increasing progression-free interval , and , if possible , to prolong life . With non-platinum agents , monotherapy should be considered because no advantage appears to accrue to the use of non-platinum-containing combination chemotherapy in this group of patients . Single-agent paclitaxel , topotecan , or pegylated liposomal doxorubicin have demonstrated activity in this patient population and are reasonable treatment options . No evidence either supports or refutes the use of more than one line of chemotherapy in patients with platinum-refractory or platinum-resistant recurrence . Many treatment options have shown modest response rates , but their benefits over best supportive care have not been studied in clinical trials This phase II study evaluates the efficacy and toxicity of a prolonged schedule of oral etoposide in patients with measurable advanced ovarian cancer resistant to , or relapsed following , platinum-based chemotherapy . Forty-seven patients participated , 20 of whom had received more than one prior treatment . Seventy-seven per cent had evidence of disease progression during or within 6 months of the previous chemotherapy . Initially , oral etoposide , 50 mg b.d . ( regardless of patient size ) , was given for 14 days on a 21-day cycle . However , after encountering toxicity , the schedule was modified to 7 days ' treatment escalating to 10 then 14 days if well tolerated . Among 41 assessable patients there were two complete and eight partial objective responses ( 24 % response rate ; 95 % confidence interval 12 - 41 % ) . Nine further patients ( 22 % ) had stable disease , four with a sustained fall of > 50 % in CA-125 . Median duration of response or stable disease was 35 weeks ( range 21 - 49 ) . Overall median survival was 41 weeks from study entry ( range 2 to 96 + weeks ) . Toxicity for most patients was mild , but sporadic severe myelotoxicity occurred , with two treatment-related deaths . Risk factors for severe toxicity were : performance status 3 ; hepatic impairment ; renal impairment . We conclude that oral etoposide has activity in platinum-resistant ovarian cancer and that it is a useful palliative therapy . It has significant toxicity which may be avoided by appropriate patient selection and an escalating- duration schedule PURPOSE The aim of this study was to perform an evaluation of outcome and the role of surgical staging components in malignant germ cell tumors ( GCT ) of the ovary in children and adolescents . METHODS From 1990 to 1996 , 2 intergroup trials for malignant GCT were undertaken by Pediatric Oncology Group ( POG ) and Children 's Cancer Study Group ( CCG ) . Stage I-II patients were treated with surgical resection and 4 cycles of st and ard dose cisplatin ( 100 mg/m2/cycle ) , etoposide , and bleomycin ( PEB ) chemotherapy . Stage III-IV patients were treated with surgical resection and r and omly assigned to chemotherapy with PEB or high-dose cisplatin ( 200 mg/m2/cycle ) with etoposide and bleomycin ( HDPEB ) . Patients unresectable at diagnosis had second-look operation after 4 cycles of chemotherapy if residual tumor was seen on imaging studies . IRB approval of the protocol s was obtained at each participating institution . An analysis of outcome data , operative notes , and pathology reports in girls with ovarian primary site was done for this report . RESULTS There were 131 patients with ovarian primary tumors of 515 entered on these studies . Mean age was 11.9 years ( range , 1.4 to 20 years ) .  Six-year survival rate was stage , I 95.1 % ; stage II , 93.8 % ; stage III , 98.3 % ; stage IV , 93.3 % . In only 3 of 131 patients were surgical guidelines followed completely . Surgical omissions result ing in protocol noncompliance result ed from failure to biopsy bilateral nodes ( 97 % ) , no omentectomy ( 36 % ) , no peritoneal cytology ( 21 % ) , no contralateral ovary biopsy ( 59 % ) . More aggressive procedure than recommended by guidelines included total hysterectomy and bilateral salpingo-oophorectomy in 6 patients and retroperitoneal node dissection in 10 patients . Correlation of gross operative findings with pathology results was carried out for ascites , lymph nodes , implants , omentum , and contralateral ovary . CONCLUSIONS Pediatric ovarian malignant GCT ( stages I-IV ) have excellent survival with conservative surgical resection and platinum-based chemotherapy . Survival appears to have been unaffected by deviations from surgical guidelines . New surgical guidelines are proposed based on correlation of gross findings , histology , and outcome in these intergroup trials PURPOSE In r and omized trials the combination of cisplatin and paclitaxel was superior to cisplatin and cyclophosphamide in advanced-stage epithelial ovarian cancer . Although in nonr and omized trials , carboplatin and paclitaxel was a less toxic and highly active combination regimen , there remained concern regarding its efficacy in patients with small-volume , resected , stage III disease . Thus , we conducted a noninferiority trial of cisplatin and paclitaxel versus carboplatin and paclitaxel in this population . PATIENTS AND METHODS Patients with advanced ovarian cancer and no residual mass greater than 1.0 cm after surgery were r and omly assigned to receive cisplatin 75 mg/m2 plus a 24-hour infusion of paclitaxel 135 mg/m2 ( arm I ) , or carboplatin area under the curve 7.5 intravenously plus paclitaxel 175 mg/m2 over 3 hours ( arm II ) . RESULTS Seven hundred ninety-two eligible patients were enrolled onto the study . Prognostic factors were similar in the two treatment groups . Gastrointestinal , renal , and metabolic toxicity , as well as grade 4 leukopenia , were significantly more frequent in arm I. Grade 2 or greater thrombocytopenia was more common in arm II . Neurologic toxicity was similar in both regimens . Median progression-free survival and overall survival were 19.4 and 48.7 months , respectively , for arm I compared with 20.7 and 57.4 months , respectively , for arm II . The relative risk ( RR ) of progression for the carboplatin plus paclitaxel group was 0.88 ( 95 % confidence interval [ CI ] , 0.75 to 1.03 ) and the RR of death was 0.84 ( 95 % CI , 0.70 to 1.02 ) . CONCLUSION In patients with advanced ovarian cancer , a chemotherapy regimen consisting of carboplatin plus paclitaxel results in less toxicity , is easier to administer , and is not inferior , when compared with cisplatin plus paclitaxel Objective . Currently , no prospect i ve study supports or refutes the value of  secondary cytoreductive surgery in patients with ovarian cancer . We therefore review ed the surgical data of patients who underwent second‐look laparotomy ( SLL ) with or without secondary cytoreductive surgery at our department BACKGROUND Borderline ovarian tumors often affect women of childbearing age and the prognosis is outst and ing . Given the young age of several patients and the good prognosis , fertility-sparing surgery is considered adequate for stage I tumors . However , women treated conservatively have a relatively small but well-defined risk of recurrence and no study has specifically addressed the optimal follow-up technique . METHODS From 1981 to 1997 , 164 women underwent fertility-sparing surgery for stage I borderline ovarian tumor and were followed prospect ively . After surgery all women underwent physical examination and ultrasound examination every 3 months for 2 years after first diagnosis and every 6 months thereafter . Measurement of serum CA 125 levels was planned every 6 months in patients with a serous tumor . RESULTS With a median follow-up of 71 , months 28 women treated with fertility-sparing surgery ( 28/164 = 17 % ) had either recurrence of borderline tumor ( 23 ) or recurrence with carcinoma . Complete details of follow-up procedures are available for 24 women and they represent the study population . An abnormal adnexal mass was detected in 18 of 19 women with recurrent borderline tumor . One patient had diagnosis due to persistent free fluid . All five women with invasive carcinoma had diagnosis of a complex adnexal mass . Gynecologic examination was suspicious ( palpable mass ) in 7 cases and obviously abnormal ( large mass or nodules ) in another 7 . CA 125 serum levels were elevated in 8 cases . CONCLUSION Transvaginal ultrasound is currently the most effective diagnostic technique for the follow-up of young patients treated conservatively for early borderline ovarian tumor BACKGROUND The question of whether platinum-based adjuvant chemotherapy can improve outcomes in patients with early-stage epithelial ovarian cancer is an important one . We carried out a multicenter , open r and omized trial to determine whether adjuvant chemotherapy would improve overall survival and prolong recurrence-free survival in women with early-stage epithelial ovarian cancer . METHODS Between August 1991 and January 2000 , 477 patients in 84 centers in five countries were r and omly assigned to receive either adjuvant chemotherapy immediately following surgery ( n = 241 ) or no adjuvant chemotherapy until clinical ly indicated ( n = 236 ) . Kaplan-Meier curves of overall survival and recurrence-free survival were compared using the Mantel-Cox version of the log-rank test . All statistical tests were two-sided . RESULTS Women who received adjuvant chemotherapy had better overall survival than women who did not ( hazard ratio [ HR ] of 0.66 , 95 % confidence interval [ CI ] = 0.45 to 0.97 ; P = .03 ) . These results translate into 5-year survival figures of 70 % for women who did not receive adjuvant chemotherapy and 79 % for women who did receive adjuvant chemotherapy , a difference of 9 % ( 95 % CI = 1 % to 15 % ) . Adjuvant chemotherapy also improved recurrence-free survival ( HR = 0.65 ; 95 % CI = 0.46 to 0.91 ; P = .01 ) . These results translate into 5-year recurrence-free survival figures of 62 % for women who did not receive adjuvant chemotherapy and 73 % for women who did receive adjuvant chemotherapy , a difference of 11 % ( 95 % CI = 3 % to 18 % ) . CONCLUSION These results suggest that platinum-based adjuvant chemotherapy improves survival and delays recurrence in patients with early-stage ovarian cancer Many patients with advanced ovarian cancer will develop recurrent disease . For those patients who have recurrence of disease at least 6 months after initial therapy , the paclitaxel – platinum combination has been shown to be a superior treatment to platinum monotherapy . However , many patients develop clinical ly relevant neurotoxicity , frequently result ing in treatment discontinuation . The efficacy and safety of an alternative regimen that does not show significant neurotoxicity were evaluated by comparing gemcitabine – carboplatin with carboplatin in platinum-sensitive recurrent ovarian cancer patients in a Gynecologic Cancer InterGroup trial of the Arbeitsgemeinschaft Gynakologische Onkologie Ovarian Cancer Study Group , the National Cancer Institute of Canada Clinical Trials Group , and the European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group . Participants with recurrent platinum-sensitive ovarian cancer were r and omly assigned to receive either gemcitabine – carboplatin or carboplatin every 21 days . The primary objective was to compare progression-free survival ( PFS ) between the groups . From September 1999 to April 2002 , 356 patients ( 178 participants received gemcitabine – carboplatin , 178 received carboplatin only ) were r and omized to treatment . Patients received six cycles of either gemcitabine – carboplatin or carboplatin . With a median follow-up of 17 months , median PFS was 8.6 months for gemcitabine – carboplatin ( 95 % confidence interval [ CI ] 7.9–9.7 months ) and 5.8 months for carboplatin ( 95 % CI 5.2–7.1 months ; hazard ratio [ HR ] 0.72 [ 95 % CI 0.58–0.90 ; P = 0.0032 ] ) . The response rate for the gemcitabine – carboplatin group was 47.2 % ( 95 % CI 39.9–54.5 % ) and 30.9 % for carboplatin group ( 95 % CI 24.1–37.7 % ; P = 0.0016 ) . The HR for overall survival was 0.96 ( 95 % CI 0.75–1.23 ; P = 0.7349 ) . Patients treated with gemcitabine – carboplatin reported significantly faster palliation of abdominal symptoms and a significantly improved global quality of life .  Gemcitabine – carboplatin treatment significantly improves the PFS of patients with platinum-sensitive recurrent ovarian cancer BACKGROUND Paclitaxel and carboplatin given every 3 weeks is st and ard treatment for advanced ovarian carcinoma . Attempts to improve patient survival by including other drugs have yielded disappointing results . We compared a conventional regimen of paclitaxel and carboplatin with a dose-dense weekly regimen in women with advanced ovarian cancer . METHODS Patients with stage II to IV epithelial ovarian cancer , fallopian tube cancer , or primary peritoneal cancer were eligible for enrolment in this phase 3 , open-label , r and omised controlled trial at 85 centres in Japan . Patients were r and omly assigned by computer-generated r and omisation sequence to receive six cycles of either paclitaxel ( 180 mg/m(2 ) ; 3-h intravenous infusion ) plus carboplatin ( area under the curve [ AUC ] 6 mg/mL per min ) , given on day 1 of a 21-day cycle ( conventional regimen ; n=320 ) , or dose-dense paclitaxel ( 80 mg/m(2 ) ; 1-h intravenous infusion ) given on days 1 , 8 , and 15 plus carboplatin given on day 1 of a 21-day cycle ( dose-dense regimen ; n=317 ) . The primary endpoint was progression-free survival . Analysis was by intention to treat ( ITT ) . This trial is registered with Clinical Trials.gov , number NCT00226915 . FINDINGS 631 of the 637 enrolled patients were eligible for treatment and were included in the ITT population ( dose-dense regimen , n=312 ; conventional regimen , n=319 ) . Median progression-free survival was longer in the dose-dense treatment group ( 28.0 months , 95 % CI 22.3 - 35.4 ) than in the conventional treatment group ( 17.2 months , 15.7 - 21.1 ; hazard ratio [ HR ] 0.71 ; 95 % CI 0.58 - 0.88 ; p=0.0015 ) . Overall survival at 3 years was higher in the dose-dense regimen group ( 72.1 % ) than in the conventional treatment group ( 65.1 % ; HR 0.75 , 0.57 - 0.98 ; p=0.03 ) . 165 patients assigned to the dose-dense regimen and 117 assigned to the conventional regimen discontinued treatment early . Reasons for participant dropout were balanced between the groups , apart from withdrawal because of toxicity , which was higher in the dose-dense regimen group than in the conventional regimen group ( n=113 vs n=69 ) . The most common adverse event was neutropenia ( dose-dense regimen , 286 [ 92 % ] of 312 ; conventional regimen , 276 [ 88 % ] of 314 ) . The frequency of grade 3 and 4 anaemia was higher in the dose-dense treatment group ( 214 [ 69 % ] ) than in the conventional treatment group ( 137 [ 44 % ] ; p<0.0001 ) . The frequencies of other toxic effects were similar between groups . INTERPRETATION Dose-dense weekly paclitaxel plus carboplatin improved survival compared with the conventional regimen and represents a new treatment option in women with advanced epithelial ovarian cancer . FUNDING Bristol-Myers Squibb OBJECTIVES To assess feasibility , complications and efficacy of secondary surgical cytoreduction ( CRS ) and hyperthermic intraperitoneal chemotherapy ( HIPEC ) in a selected group of platinum-sensitive recurrent ovarian cancer patients . METHODS Recurrent ovarian cancer patients with a platinum-free interval of at least 6 months were prospect ively enrolled . After complete CRS they were su bmi tted to intraperitoneal perfusion of oxaplatinum ( 460 mg/m(2 ) ) heated to 41.5 degrees C for 30 min . Then they received systemic chemotherapy with taxotere 75 mg/m(2 ) and oxaliplatin 100 mg/m(2 ) for 6 cycles . Patients were followed up routinely until recurrence or death . RESULTS Twenty-five recurrent ovarian cancer patients were valuable for the study . The median Platinum Free Interval ( PFI ) was 25 months ( range 7 - 67 ) . The majority of the patients ( 76 % ) had diffuse carcinosis . Nobody had ascites . An optimal residual disease was obtained in all patients . The median duration of CRS+HIPEC  was 312 min ( range 138 - 619 ) . Median intensive care unit ( ICU ) stay was 2 days ( 1 - 6 ) , median hospital stay was 13 days ( 7 - 30 ) . Post-operative major complications were observed in 7 patients ( 28 % ) . Post-operative mortality was 0 % . With a median follow-up time of 18 months ( range 3 - 38 ) , 24 patients ( 96 % ) are alive , but seven women ( 28 % ) have relapsed . CONCLUSIONS Adequate pre-operative selection can improve feasibility of CRS and HIPEC .  Morbidity rate is comparable to aggressive cytoreduction without HIPEC . Although associated with some post-operative morbidity , long-term results are encouraging , waiting for larger series and longer follow-up data PURPOSE The management of recurrent ovarian cancer remains controversial . Single-agent topotecan is an established treatment option , and preliminary evidence suggests improved tumor control by combining topotecan with etoposide or gemcitabine . PATIENTS AND METHODS Women with relapsed ovarian cancer after primary surgery and platinum-based chemotherapy were r and omly assigned to topotecan monotherapy 1.25 mg/m(2)/d , topotecan 1.0 mg/m(2 ) plus oral etoposide 50 mg/d , or topotecan 0.5 mg/m(2)/d plus gemcitabine 800 mg/m(2 ) on day 1 and 600 mg/m(2 ) on day 8 every 3 weeks . Patients were stratified for platinum-refractory and platinum-sensitive disease according to a recurrence-free interval of less or more than 12 months , respectively . The primary end point was overall survival . Secondary end points included progression-free survival , objective response rates , toxicity , and quality of life ( as measured by the European Organisation for Research and Treatment of Cancer [ EORTC ] 30-item Quality -of-Life Question naire ) . RESULTS The trial enrolled 502 patients with a mean age of 60.5 years ( + /- 10.2 years ) , 208 of whom were platinum resistant .  Median overall survival was 17.2 months ( 95 % CI , 13.5 to 21.9 months ) with topotecan , 17.8 months ( 95 % CI , 13.7 to 20.0 months ) with topotecan plus etoposide ( log-rank P = .7647 ) , and 15.2 months ( 95 % CI , 11.3 to 20.9 months ) with topotecan plus gemcitabine ( log-rank P = .2344 ) . Platinum-sensitive patients lived significantly longer than platinum-refractory patients ( 21.9 v 10.6 months ) . The median progression-free survival was 7.0 , 7.8 , and 6.3 months , respectively . Objective response rates were 27.8 % , 36.1 % , and 31.6 % , respectively . Patients under combined treatment were at higher risk of severe thrombocytopenia . CONCLUSION Nonplatinum topotecan combinations do not provide a survival advantage over topotecan alone in women with relapsed ovarian cancer PURPOSE This phase II study was design ed to determine the toxicity and activity of single-agent gemcitabine in heavily pretreated patients with germ cell tumors . PATIENTS AND METHODS From March 1996 through November 1997 , 21 patients were enrolled onto a phase II study of  gemcitabine 1,200 mg/m2 , given on days 1 , 8 , and 15 every 4 weeks . One patient was unassessable because he never received any gemcitabine .  Thirteen of 20 patients had received three prior regimens , and 13 patients were platinum refractory ( progression during or within 4 weeks of platinum treatment ) . There were five extragonadal cases and two patients with late relapse ( relapse beyond 2 years ) . RESULTS Gemcitabine was well tolerated . Only one patient had grade 3 or 4 nonhematologic toxicity ( grade 3 nausea ) . Six of 20 patients had grade 3 leukopenia . There were no episodes of granulocytopenic fever , and no patient required platelet transfusion . Three ( 15 % ) of 20 patients achieved an objective response , including one complete remission . Three additional patients had a minor radiographic or serologic response . CONCLUSION Gemcitabine had definite activity in this heavily pretreated germ cell tumor patient population Because of scarce data from larger series and nonhomogeneous selection criteria , further information is needed on peritonectomy with hyperthermic intraperitoneal chemotherapy ( HIPEC ) in managing patients with ovarian peritoneal carcinomatosis PURPOSE The objective of this study was to compare the quality of life ( QoL ) of ovarian cancer patients treated with paclitaxel/carboplatin ( TC ) versus paclitaxel/cisplatin ( PT )  and to determine the impact of treatment toxicity on the various QoL domains . PATIENTS AND METHODS In this phase III trial , 798 patients with ovarian cancer stages IIB-IV were r and omly assigned to receive TC or PT .  The primary end point was progression-free survival ; secondary end points included toxicity , QoL , and response to treatment . Patients completed the European Organisation for Research and Treatment of Cancer QLQ-C30 before treatment , within 3 days before the second and the fourth chemotherapy cycle , and 3 weeks after completion of chemotherapy . RESULTS Previously reported data showed that patients undergoing TC or PT did not differ in progression-free survival and overall survival . However , the TC arm was superior , indicating a better overall QoL compared with the PT arm . Controlling for toxicity and age , a significant treatment by assessment time interaction was found for four QoL functioning scales and three symptoms scales . Patients in the TC arm showed better means scores after treatment on overall QoL ( P = .012 ) , physical functioning ( P = .012 ) , role functioning ( P = .005 ) , and cognitive functioning ( P = .024 ) , compared with the PT arm . Concerning symptom experience , patients undergoing TC showed less nausea and vomiting ( P < .001 ) , less appetite loss ( P < .001 ) , and less fatigue ( P = .033 ) after completion of treatment compared with patients undergoing PT . CONCLUSION The TC regimen achieved better QoL outcomes compared with the PT regimen . Thus , clinicians may consider replacing cisplatin with carboplatin when treating ovarian cancer patients with chemotherapy This study defines the psychometric properties of the European Organisation for Research and Treatment of Cancer ( EORTC ) quality of life ( QOL ) question naire design ed to measure the QOL of patients with ovarian cancer . The ovarian cancer module ( EORTC QLQ-OV28 ) was developed to supplement the EORTC QLQ-C30 . The core question naire and the QLQ-OV28 were prospect ively administered to 368 ovarian cancer patients after they had been treated with radical or debulking surgery followed by chemotherapy .  The QLQ-OV28 module assesses abdominal/gastrointestinal symptoms , peripheral neuropathy , other chemotherapy side-effects , hormonal/menopausal symptoms , body image , attitude to disease/treatment and sexual functioning . Question naires were well accepted by patients , baseline compliance rates were 86 % , 72 % provided a second assessment , less than 3 % of the items had missing data . Multi-trait scaling analyses confirmed the hypothesised scales . All hypothesised scales exhibited good psychometric properties . These results support the clinical and psychometric validity of the EORTC QLQ-OV28 module as a supplement to the EORTC QLQ-C30 Primary surgery followed by platinum‐taxane based chemotherapy has been the st and ard therapy in advanced ovarian cancer . However , the prognostic role of complete and so‐called optimal and suboptimal debulking and its interaction with biological factors has not been not fully defined PURPOSE To assess progression-free survival ( PFS ) and overall survival ( OS ) in patients with suboptimally debulked epithelial ovarian cancer receiving cisplatin ( 100 mg/m(2 ) ) or 24-hour infusion paclitaxel ( 200 mg/m(2 ) ) or the combination of paclitaxel ( 135 mg/m(2 ) ) followed by cisplatin ( 75 mg/m(2 ) ) . PATIENTS AND METHODS After stratification for disease measurability , patients were r and omized to receive six cycles of one of the treatments every 3 weeks . If measurable , complete response ( CR ) or partial response ( PR ) was determined . RESULTS Six hundred fourteen of 648 patients who entered onto the trial were eligible . Monotherapies were discontinued more frequently ( cisplatin because of toxicity or patient refusal [ 17 % ] , and paclitaxel because of progression [ 20 % ] ) compared with the combination therapy ( 7 % and 6 % , respectively ) . Neutropenia , fever , and alopecia were more severe with paclitaxel-containing regimens ; whereas anemia , thrombocytopenia , neurotoxicity , nephrotoxicity , and gastrointestinal toxicity were more severe with cisplatin-containing regimens . The CR/PR rates on paclitaxel monotherapy were significantly lower compared with the cisplatin regimens ( 42 % v 67 % , respectively ; P < .001 ) . The relative hazard ( RH ) of first progression or death was significantly greater among those r and omized to paclitaxel ( RH = 1.41 ; 95 % confidence interval [ CI ] , 1.15 to 1.73 ; P < .001 ) when compared with cisplatin ; however , RH did not differ significantly between the two cisplatin regimens ( RH = 1.06 ; 95 % CI , 0.895 to 1.30 ) . Relative to cisplatin , the death rate on paclitaxel was 15 % greater ( RH = 1.15 ; 95 % CI , 0 . 929 to 1.42 ) , and the death rate on the combination treatment was 1 % less ( RH = 0.99 ; 95 % CI , 0.795 to 1.23 ) . These differences among treatment groups were not statistically significant ( P = .31 ) . CONCLUSION Cisplatin alone or in combination yielded superior response rates and PFS relative to paclitaxel . However , OS was similar in all three arms , and the combination therapy had a better toxicity profile . Therefore , the combination of cisplatin and paclitaxel remains the preferred initial treatment option A case-control study of reproductive factors and cancer of the ovary was conducted during 1989 - 1992 in metropolitan Toronto and nearby areas of Southern Ontario , Canada . In total , 450 women aged 35 - 79 years with histologically verified new primary epithelial ovarian cancers were interviewed concerning their reproductive histories . Over the same time period , 564 r and omly selected population controls , frequency-matched to the cases according to three 15-year age groups , were also interviewed . Continuous unconditional logistic regression methods were used for analysis . It was found that childbearing and use of oral contraceptives were associated with significant decreasing trends in risk of ovarian cancer ; the respective odds ratios were 0.78 for each full-term pregnancy ( p < 10(-8 ) ) and 0.92 for each year of use ( p < 10(-6 ) ) . Hysterectomy was also associated with reduced risk , even after more than 20 years . Among parous women , infertility did not appear to affect risk ; for nulliparous women , some evidence of increased risk was present , although fertility problems were reported by only a small fraction of nulliparae . It is suggested that the relatively lower parity of cases as compared with controls may be due to voluntary choices for having fewer children OBJECTIVE Provide long-term follow-up data for women treated in a r and omized multicenter study of  pegylated liposomal doxorubicin compared with topotecan . METHODS Patients with epithelial ovarian cancer that recurred after or failed to respond to first-line platinum-based chemotherapy were r and omized to receive  pegylated liposomal doxorubicin 50 mg/m(2 ) every 28 days ( n = 239 ) or topotecan 1.5 mg/m(2 ) per day for 5 days every 21 days ( n = 235 ) . Patients were stratified prospect ively based on response to initial platinum-based chemotherapy as well as the presence or absence of bulky disease . Most patients had been previously treated with platinum and taxanes ( 74 % in the pegylated liposomal doxorubicin group and 72 % in the topotecan group ) .  Survival data are mature : 87 % of patients have died ( n = 413 ) . RESULTS There was an 18 % reduction in the risk of death for patients treated with pegylated liposomal doxorubicin ( median survival 62.7 weeks for pegylated liposomal doxorubicin and 59.7 weeks for topotecan-treated patients ; HR = 1.216 ; 95 % confidence interval ( CI ) 1.000 - 1.478 ; P = 0.050 ) . The hazard ratio for all r and omized subjects ( includes those r and omized , but never treated ; n = 481 ) was 1.23 ( median survival 63.6 weeks for pegylated liposomal doxorubicin and 57.0 weeks for topotecan-treated patients ; 95 % CI 1.01 - 1.50 ; P = 0.038 ) . For patients with platinum-sensitive disease , there was a 30 % reduction in the risk of death for the pegylated liposomal doxorubicin-treated group ( median survival 107.9 weeks for pegylated liposomal doxorubicin and 70.1 weeks for topotecan-treated patients ; HR = 1.432 ; 95 % CI 1.066 - 1.923 ; P = 0.017 ) . In patients with platinum-refractory disease , survival was similar between treatment groups . CONCLUSION Long-term follow-up demonstrates that treatment with pegylated liposomal doxorubicin significantly prolongs survival compared with topotecan in patients with recurrent and refractory epithelial ovarian cancer . The survival benefit is pronounced in patients with platinum-sensitive disease PURPOSE To retrospectively review our experience using radiation therapy as a palliative treatment in ovarian carcinoma . METHODS AND MATERIAL S Eighty patients who received radiation therapy for ovarian carcinoma between 1983 and 1998 were review ed . The indications for radiation therapy , radiation therapy techniques , details , tolerance , and response were recorded . A complete response required complete resolution of the patient 's symptoms , radiographic findings , palpable mass , or CA-125 level . A partial response required at least 50 % resolution of these parameters . The actuarial survival rates from initial diagnosis and from the completion of radiation therapy were calculated . RESULTS The median age of the patients was 67 years ( range 26 to 90 years ) . A median of one laparotomy was performed before irradiation . Zero to 20 cycles of a platinum-based chemotherapy regimen were delivered before irradiation ( median = 6 cycles ) . The reasons for palliative treatment were : pain ( n = 22 ) , mass ( n = 23 ) , obstruction of ureter , rectum , esophagus , or stomach ( n = 12 ) , a positive second-look laparotomy ( n = 9 ) , ascites ( n = 8) , vaginal bleeding ( n = 6 ) , rectal bleeding ( n = 1 ) , lymphedema ( n = 3 ) , skin involvement ( n = 1 ) , or brain metastases with symptoms ( n = 11 ) . Some patients received treatment for more than one indication . Treatment was directed to the abdomen or pelvis in 64 patients , to the brain in 11 , and to other sites in 5 . The overall response rate was 73 % . Twenty-eight percent of the patients experienced a complete response of their symptoms , palpable mass , and /or CA-125 level . Forty-five percent had a partial response . Only 11 % suffered progressive disease during therapy that required discontinuation of the treatment . Sixteen percent had stable disease . The duration of the responses and stable disease lasted until death except in 10 patients who experienced recurrence of their symptoms between 1 and 21 months ( median = 9 months ) . The 1- , 2- , 3- , and 5-year actuarial survival rates from diagnosis were 89 % , 73 % , 42 % , and 33 % , respectively . The survival rates calculated from the completion of radiotherapy were 39 % , 27 % , 13 % , and 10 % , respectively . Five percent of patients experienced Grade 3 diarrhea , vomiting , myelosuppression , or fatigue . Fourteen percent of patients experienced Grade 1 or 2 diarrhea , 19 % experienced Grade 1 or 2 nausea and vomiting , and 11 % had Grade 1 or 2 myelosuppression . CONCLUSIONS In this series of radiation therapy for advanced ovarian carcinoma , the response , survival , and tolerance rates compare favorably to those reported for current second- and third-line chemotherapy regimens . Cooperative groups should consider evaluating prospect ively the use of radiation therapy before nonplatinum and /or nonpaclitaxel chemotherapy in these patients OBJECTIVE The Gynecologic Oncology Group has divided patients with advanced epithelial ovarian cancer into those with optimal residual cancer , in which the maximum diameter of residual is < or = 1 cm , and suboptimal residual cancer , in which the residual disease is > 1 cm . Within the optimal group of patients there is a survival difference between patients with microscopic residual disease and those with any macroscopic disease < or = 1 cm . No analysis of the effect of various residual disease diameters in patients with residual disease > or = 1 cm has been performed . This study evaluates the effect of residual disease diameter in patients with suboptimal disease entered on a r and omized trial of intense versus st and ard chemotherapy .  STUDY DESIGN Gynecologic Oncology Group protocol 97 compared cisplatin 50 mg/m2 and cyclophosphamide 500 mg/m2 for eight courses with the same drugs at 100 mg/m2 and 1000 mg/m2 for four courses , respectively . There was no difference in progression-free interval or survival between the two arms . Of the 458 stage III ( with residual disease > 1 cm ) and stage IV patients entered in this study , 294 stage III patients comprise the current analysis . Surgical reporting forms , operation reports , and pathology reports were review ed to determine initial greatest tumor diameter and residual tumor diameter . Patients were grouped by residual diameter . Multivariate analysis considered residual diameter of disease , age , histologic characteristics , performance status , and ascites . An adjusted relative hazard of dying of ovarian cancer was calculated for each residual disease group . RESULTS Patients ranged in age from 20 to 80 years , with a median of 60 years . All patients were Gynecologic Oncology Group performance status 0 to 2 . Fifty-two percent had grade 3 tumors , and 39 % and 9 % , respectively , had grade 2 or 1 tumors . All patients had stage III disease . Ninety percent had serous , endometrioid , or mixed epithelial cell type tumors . Multivariate analysis revealed a relative risk of dying as follows : residual disease < 2 cm , relative risk 1.00 ; 2 to 2.9 cm , relative risk 1.90 ; 3 to 3.9 cm , relative risk 1.91 ; 4 to 5.9 cm , relative risk 1.74 ; 6 to 7.9 cm , relative risk 1.85 ; 8 to 9.9 cm , relative risk 2.16 ; > or = 10 cm , relative risk 1.82 . The difference in survival between those with < 2 cm residual disease and those with > or = 2 cm residual disease was significant ( p < 0.01 ) . There is no significant difference in the risk of dying between groups with residual disease > or = 2 cm . CONCLUSIONS Among patients with suboptimal ( > 1 cm residual disease ) epithelial ovarian cancer , those who have small diameter residual disease ( < 2 cm ) tend to survive longer than those who have larger residual disease . Among those with larger residual disease , size does not affect prognosis appreciably OBJECTIVE A non-r and omized comparison of outcome in women undergoing second-look laparotomy ( SLL ) or clinical follow-up , after receiving six cycles of combination chemotherapy with paclitaxel plus either cisplatin or carboplatin , for optimally resected stage III ovarian cancer . METHODS Prior to chemotherapy r and omization , patients chose whether or not to undergo SLL ; this was a stratification factor to insure balance of treatment assignment . Any subsequent therapy was physician-directed . Explanatory analysis replaced intent-to-treat because of a higher likelihood of detecting SLL effect in the presence of noncompliance . RESULTS There were 393 patients ( median age : 54 ) who Elected SLL and 399 ( median age : 59 ) who Elected No SLL . The former group was more likely to have gross residual disease at initial surgery than the latter group ( 69 % versus 60 % , respectively ) . In the Elected SLL group , 59 ( 15 % ) patients subsequently refused surgery , in nine ( 2 % ) surgery was contraindicated , and 31 ( 8 % ) relapsed or died prior to the procedure . Cancer was found in 46 % of 294 ( 75 % ) patients undergoing SLL . Since early failures ( prior to SLL ) do not address benefit , such patients ( SLL : 32 ; No SLL : 33 ) , defined as progression-free survival ( PFS ) < 6 months , were excluded from analysis . The adjusted relative risk of progression is 0.89 ( 95 % confidence interval : 0.75 , 1.07 ) ; the difference in median PFS is 1.0 month ( SLL : 23.9 months ; No SLL : 22.9 months ) . The survival rate curves are superimposable . CONCLUSION In the context of a non-r and omized comparison , the performance of a SLL was not associated with longer survival Objective : To report and evaluate a conservative and individualized treatment policy in a homogeneously selected series of patients affected by pure ovarian immature teratoma . Methods : This prospect i ve trial , with specific treatment policies according to stage and grade , was planned and started in 1982 . The study population consisted of 32 patients affected by pure immature teratoma , with the exclusion of mixed germ cell tumors .  Fertility-sparing surgery was performed whenever possible . Surgery alone , with careful follow-up , was adopted for stage I or II according to the International Federation of Gynecology and Obstetrics ( FIGO ) and grade 1 or 2 tumors . The other patients , with stage III or with grade 3 stage I or II tumors , or those referred at relapse , were treated with platinum-based chemotherapy regimens . Results : Thirty of 32 patients underwent fertility-sparing surgery . Ten of 32 patients received chemotherapy after surgery , either as adjuvant treatment or in the presence of visible tumor . All 32 patients are alive and disease-free , with a median follow-up from surgery of 47 months ( range 11–138 ) . In six patients , regardless of the administration of chemotherapy , the tumor either spontaneously differentiated toward mature glia or increased in volume , mimicking progression but still remaining completely mature . Five of six patients wishing to procreate had a total of seven normal pregnancies . Conclusions : Pure ovarian immature teratoma is a potentially curable disease with a unique natural history . Our data substantiate the hypothesis that low- grade and low-stage tumors do not require chemotherapy , and that a fertility-sparing surgical approach is warranted in all cases PURPOSE A large , r and omized study comparing the efficacy and safety of topotecan versus paclitaxel in patients with relapsed epithelial ovarian cancer showed that these two compounds have similar activity . In this study , a number of patients crossed over to the alternative drug as third-line therapy , ie , from paclitaxel to topotecan and vice versa . We therefore were able to assess the degree of non-cross-resistance between these two compounds . PATIENTS AND METHODS Patients who had progressed after one platinum-based regimen  were r and omized to either topotecan ( 1.5 mg/m(2)/d ) x 5 every 21 days ( n = 112 ) or paclitaxel ( 175 mg/m(2 ) over 3 hours ) every 21 days ( n = 114 ) . A total of 110 patients received cross-over therapy with the alternative drug ( 61 topotecan , 49 paclitaxel ) as third-line therapy . RESULTS Response rates to third-line cross-over therapy were 13.1 % ( 8 of 61 topotecan ) and 10.2 % ( 5 of 49 paclitaxel ; P = .638 ) . Seven patients who responded to third-line topotecan and four patients who responded to paclitaxel had failed to respond to their second-line treatment . Median time to progression ( from the start of third-line therapy ) was 9 weeks in both groups , and median survival was 40 and 48 weeks for patients who were receiving topotecan or paclitaxel , respectively . The principal toxicity was myelosuppression ; grade 4 neutropenia was more frequent with topotecan ( 81.4 % of patients ) than with paclitaxel ( 22.9 % of patients ) . CONCLUSION Topotecan and paclitaxel have similar activity as second-line therapies with regard to response rates and progression-free and overall survival . We demonstrated that the two drugs have a degree of non-cross-resistance . Thus , there is a good rationale for incorporating these drugs into future first-line regimens LBA5007 Background : BEV , a humanized anti-VEGF monoclonal antibody , has shown a progression-free survival ( PFS ) benefit in 2 frontline phase III trials in patients with EOC , PPC and FTC . The therapeutic impact of BEV in combination with carboplatin ( C ) and gemcitabine ( G ) followed by single agent BEV to disease progression ( PD ) was evaluated in this phase III trial in the platinum-sensitive recurrent setting . METHODS Patients had recurrent , platinum-sensitive EOC , PPC or FTC , 1 prior regimen , no prior BEV , ECOG performance status 0 - 1 , measurable disease . Subjects were r and omized to : Arm A : [ IV C ( AUC 4 , Day ( D ) 1 ) + G ( 1,000 mg/m2 D1 and 8) + placebo ( PL ) D1 ] q21D x 6 cycles ( c ) → PL q21D until PD or unacceptable toxicity ( tox ) Arm B : [ CG + BEV ( 15 mg/kg ) D1 ] q21D x 6 c → BEV q21D until PD or tox primary endpoint was investigator assessed PFS ( RECIST ) . Secondary endpoints included objective response ( OR ) , overall survival ( OS ) , duration of response and safety . The design provided 80 % power to detect a 27 % reduction in the hazard of progression or death in Arm B vs A , limiting the overall type I error of 5 % . RESULTS OCEANS enrolled 484 patients ( 242 per arm ) from 4/07 - 1/10 , median follow up of 24 months . BEV plus CG followed by single agent BEV to PD significantly increased PFS compared to CG alone ( HR=0.484 , p<0.0001 ) . OR increased by 21 % ( p<0.0001 ) . OS data is immature with only 29 % of patients having had an event . The safety profile was consistent with other BEV trials . CONCLUSIONS Results show a statistically significant and clinical ly relevant benefit when bevacizumab is added to chemotherapy in patients with recurrent , platinum sensitive EOC , PPC , and FTC . This is the first phase III trial of an antiangiogenic to demonstrate a clinical benefit to these patients . [ Table : see text ]
target: In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10 - 30 % of all cases , and systematic limphadenectomy , necessary to be able to obtain an adequate surgical staging .
  Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer .
  Radiotherapy can be used to palliate symptoms .
  In the present , there is not a st and ardized screening method .
  Diagnosis in early stages means a better survival .
  Radiotherapy can be indicated to palliate symptoms
background: INTRODUCTION Ovarian cancer ( OC ) is the third most common gynecologic malignancy worldwide .
  Most of cases it is of epithelial origin .
  At the present time there is not a st and ardized screening method , which makes difficult the early diagnosis .
  The 5-year survival is 90 % for early stages , however most cases present at advanced stages , which have a 5-year survival of only 5 - 20 % .
  GICOM collaborative group , under the auspice of different institutions , have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia .
  Until now , laparoscopy for diagnostic-staging surgery is not well known as a recommended method .
  In advanced stages , primary cytoreduction is recommended as initial treatment .