Adjuvant Treatment

Stage I Tumors

Since survival rate in stage I patients approaches 100%, few experts suggest any further therapy after surgical excision and simply advocate for long-term surveillance.35

Stage II-IV Tumors

Even with advanced-stage borderline tumors, long-term survival rate may be as high as 70%.3 As previously discussed, these tumors are often associated with adverse prognostic factors including extraovarian disease, microinvasion, and/or micropapillary patterns. Several groups have analyzed whether postoperative adjuvant chemotherapy administration improves survival, but there is limited support for chemotherapy, since most studies have not shown definitive benefit.1,12,36,37 For example, Barakat and colleagues36 evaluated postoperative platinum-based chemotherapy in 21 patients (only 40% with macroscopic residual tumor) and found a 62.5% complete response rate at second-look laparotomy; the remainder had stable disease (12.5%), partial response (6%), or progression (19%). In addition, the M.D. Andersen group also failed to demonstrate a survival benefit.1,12 Finally, an analysis of platinum (cisplatin/cyclophosphamide ± adriamycin) chemotherapy in borderline tumors through the Gynecologic Oncology Group (GOG) found that 9 of 32 patients had persistent disease at second-look laparotomy and that all but one patient was still alive at a median of 32 months (one had died of other causes).37

The jury remains out as to whether adjuvant chemotherapy is beneficial, and a randomized trial is not likely forthcoming because of the indolent nature of the disease and the relative rarity of advanced cases. Our current approach is to reserve offering adjuvant chemotherapy to women with macroscopic residual disease and invasive implants, but with full disclosure to the patient about the unknown benefit of this potential therapy as a survival advantage has not been documented.

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