[The postoperative therapy of epithelial ovarian carcinoma. Has systemic cytostasis replaced percutaneous radiation?]

Abstract

Background: Abdominopelvic external beam radiotherapy as a primary postoperative therapy after a comprehensive surgical staging in completely resected stages ovarian carcinoma has been used worldwide less frequently during the last decade despite proven curative effects of this therapeutic modality. Systemic chemotherapy, mostly platinum-based combination chemotherapy, has been established as a postoperative routine treatment because of the high response rates achieved in advanced cases of disease. The controversy concerning the choice of chemotherapy continues and gave rise to a review of recently reported treatment outcome data.

Patients and methods: As a result of the low incidence of ovarian carcinoma diagnosed in early stages, only a few randomized clinical trials have been performed of both systemic chemotherapy and external beam radiotherapy in intermediate/high risk patients. Thus we collected data based on a review of the literature with special regard to criteria recommended to select patients for postoperative abdominopelvic radiotherapy and chemotherapy respectively.

Results: Despite high response rates and high negative second-look operation findings to chemotherapy, the rates for cures and long-term survival have not been improved significantly and have also failed to show a significant advantage compared with results achieved by the use of external beam radiotherapeutic modalities.

Conclusions: Long-term survival rates of the relative small number of ovarian carcinoma patients in the early stages treated in prospective randomized trials comparing both treatment modalities do not justify the assumed superiority of chemotherapy over radiotherapy, but demonstrate the need and underline the importance of further randomized clinical trials. Abdominopelvic irradiation following staging laparotomy is not recommended for advanced stages and has at the most limited benefit as consolidation therapy after successfully cytoreductive chemotherapy depending on the amount of residual tumor.