Management of Advanced Invasive Ovarian Cancer

At present, the treatment of choice for patients with advanced invasive epithelial ovarian cancer is cytoreductive surgery followed by six cycles of chemotherapy with a combination of carboplatin (AUC 5-6) and paclitaxel (175 mg/M₂ over 3 h) every 3 weeks (Table 118-8). Paclitaxel is administered before the carboplatin. In patients at risk for severe neuropathy, for example, diabetics, a combination of docetaxel (75 mg/M₂) and carboplatin (AUC 5) provides an alternative that is less neurotoxic. As data confirming the SCOTROC trial are obtained, the latter regimen may become a standard option for all patients. In women who cannot tolerate the toxicity of taxanes, carboplatin alone (AUC 6-7) can be given. For the rare patient who cannot tolerate IV chemotherapy, an oral alkylating agent can be used for palliation.

Management of Advanced Borderline Tumors
The effectiveness of chemotherapy in patients with advanced-stage borderline tumors has not been established. The GOG is evaluating the use of chemotherapy in patients with advanced-stage borderline tumors who have recurrent disease after initial surgery. Until the results of this trial are known, the current approach to treatment is primarily surgical. Patients should undergo cytoreductive surgery and observation. Borderline tumors, even in advanced stage, have a favorable prognosis. The first symptomatic recurrence may be several years after diagnosis. In contrast to the 20% to 25% survival rates for advanced epithelial invasive carcinoma of the ovary, the survival rate for patients with stage III borderline tumors is over 60%.277 Consequently, secondary cytoreductive surgery frequently will lead to another prolonged interval of symptom free survival. Chemotherapy can be administered to the patients in whom cytoreductive surgery is no longer feasible, although its efficacy is uncertain.