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Women who have cancer of the ovary are usually treated initially with surgery, followed by chemotherapy or radiation therapy. If the cancer recurs (comes back) after treatment, a combination of chemotherapy drugs is often used to increase survival time and relieve the symptoms of the cancer. Now, researchers in California report that the use of a second surgery plus chemotherapy (and radiation therapy in some) to treat recurrent ovarian cancer may prolong survival times for women with this type of cancer.

Cancer of the ovary is characterized by the presence of cancer cells in the ovary. There are 2 ovaries, located on either side of the uterus, or womb. Most of these cancers are of the lining, or epithelium, of the ovary. Treatment almost always involves surgery to remove the cancer, consisting of removal of the uterus, fallopian tubes, ovaries, the fatty tissue of the abdomen, and perhaps area lymph nodes. Following the surgery, many women receive chemotherapy and/or radiation therapy. In some women who are diagnosed with advanced-stage cancer or who do not have a complete response to treatment, the cancer may come back after this initial treatment. In these cases, additional treatment usually consists of chemotherapy; however, the 5-year survival time with chemotherapy alone is only 10%. Researchers in Palo Alto sought to determine whether a second surgery could increase the survival time for women with recurrent ovarian cancer.

One hundred six women who had a recurrence of ovarian cancer 6 months or more after the initial treatment were treated again. The second treatment consisted of a second surgery to remove all visible cancer. In addition, 40% of the patients received chemotherapy before the surgery, and 60% received chemotherapy after the surgery. Some patients also received radiation therapy after the surgery. The results showed that surgeons were able to remove all visible cancer in 82% of patients. Three percent had small amounts of residual cancer remaining; 15% had large amounts of residual cancer remaining after the surgery. The average survival time with this treatment regimen was 36 months, with a 5-year survival rate of 28%. Women who had a long interval between initial treatment and the cancer recurrence had better outcomes, as did those who had only small amounts of visible cancer at the time of the second treatment. Side effects of treatment included 2 deaths from treatment-related complications.

These researchers concluded that women who have a second surgery to treat recurrent ovarian cancer appear to have a longer survival time than those who receive only chemotherapy and/or radiation therapy without surgery. (Cancer, Vol 88, No 1, pp 144-153, 2000)

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