Adjuvant Chemotherapy Should be Considered for Patients with Early-Stage cancer
According to an article published in the
Journal of the National Cancer Institute, patients with early-stage ovarian cancer have improved recurrence-free survival following adjuvant platinum-based chemotherapy.
The ovaries are two organs located on either side of the uterus. The ovaries contain eggs that are released monthly, known as ovulation. Early-stage ovarian cancer refers to cancer that has not spread from its site of origin. Specifically, stage I ovarian cancer refers to cancer that is limited to the ovaries and stage II ovarian cancer refers to cancer that is limited to the ovaries and other pelvic organs, but has not spread to the upper abdomen, lymph nodes or sites outside the abdomen. Standard therapy for patients with stages I or II ovarian cancer involves the surgical removal of the cancer with or without chemotherapy. Clinical trials have not yet definitively resolved the issue as to whether adjuvant chemotherapy improves survival in patients with early-stage ovarian cancer.
During surgery for early-stage ovarian cancer, optimal staging and debulking refers to the detection and removal of all cancer. This requires extensive inspection, palpation, tissue, lymph node and fluid sampling and removal of suspicious areas throughout the pelvis and abdomen. However, in the clinical setting, true optimal staging is difficult to achieve and not routinely performed, leaving undetectable areas of cancer remaining following surgery in a significant proportion of women. These remaining cancer cells are responsible for cancer recurrences and spread. Since optimal surgical staging and debulking is not consistently performed in the treatment of early-stage ovarian cancer, some physicians strongly advocate the use of chemotherapy following surgery in order to kill any of the remaining cancer cells.
Researchers from the European Organisation of Research and Treatment of Cancer (EORTC) recently conducted a clinical trial to compare outcomes of 448 patients from 40 medical centers and 9 European countries with stages I-II ovarian cancer. All patients were treated with the surgery and then received either adjuvant platinum-based (Paraplatin®, Platinol®) chemotherapy or no chemotherapy (observation group). Approximately 1/3 of patients in this trial were optimally staged. Nearly 5 ½ years following therapy, overall survival was similar between the two groups of patients; however, recurrence-free survival was improved by 8% in the group of patients treated with adjuvant chemotherapy. Longer follow-up may be necessary to determine if the improvement in recurrence-free survival will lead to improvement in overall long-term survival.
Upon analysis of specific variables that may confer an effect on outcomes, researchers realized that adjuvant chemotherapy did not provide a benefit to patients who were optimally staged, only to those who were not optimally staged during surgery. Furthermore, the group of patients who did not receive adjuvant chemotherapy had significantly improved cancer-free and overall survival if they were optimally staged during surgery.
The researchers concluded that adjuvant platinum-based chemotherapy improves recurrence-free survival in patients with early-stage ovarian cancer; in particular, those who are not optimally staged. Since optimal staging is largely dependent upon the skills of the surgeon and not consistently provided in clinical applications, women with early-stage ovarian cancer may wish to consider adjuvant chemotherapy. Patients with early-stage ovarian cancer may wish to speak with their physician about the risks and benefits of adjuvant chemotherapy or participation in a clinical trial further evaluating chemotherapy as part of a treatment regimen or other promising therapeutic approaches.
Reference: Trimbos J, Vergote I, Bolis G, et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer – adjuvant chemotherapy in ovarian neoplasm trial.
Journal of the National Cancer Institute. 2003;95:113-125.
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