Secondary Cytoreduction

As in most clinical situations in medicine, patient selection for a chosen treatment modality is a significant factor in the success of this treatment. In the setting of recurrent ovarian cancer, in which cure is rarely a reasonable outcome to hope for, the clinician's role is to choose among several treatment schemes meant to prolong survival with good quality of life and minimal morbidity. It is not always possible to predict the patient's response to chemotherapy or how much she will benefit from surgery, but the morbidity associated with either modality should be taken into account during counseling when recurrence is diagnosed.

In 1998, the Second International Ovarian Cancer Consensus Conference suggested several criteria for optimal candidates for secondary cytoreductive surgery11 (Box 10-2). This was an important statement that set forth long-awaited guidelines for surgery in the recurrent disease setting but that was based more on experts' opinions than on published peer-reviewed data. Several questions were still to be answered concerning secondary cytoreduction—questions regarding patient selection and goals of secondary surgery.

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