MULTIMODALITY THERAPY OF EARLY-STAGE (FIGO I-II) OVARIAN-CANCER - REVIEW OF SURGICAL-MANAGEMENT AND POSTOPERATIVE ADJUVANT TREATMENT

Two surgical aspects in the treatment of early-stage ovarian cancer de serve attention: the likelihood of retroperitoneal node involvement an d the possibility of conservative surgery in young patients who desire to preserve reproductive function. Although lymph node involvement ha s been thought to be infrequent in ovarian cancer, recent reports have documented retroperitoneal node metastases in 9.5-25% of patients wit h early-stage ovarian cancer. A current prospective randomized trial i n Italy, comparing systematic para-aortic and pelvic lymphadenectomy w ith sample biopsies of retroperitoneum in patients with early disease, should reveal whether systematic lymphadenectomy merely adds to knowl edge of the natural history of the disease or whether it will influenc e subsequent therapy and prognosis. Most researchers agree that conser vative surgery should be performed in young patients with borderline t umors and stage I, grade 1 ovarian cancer. Our experience over a 10-ye ar period in which 56% of 99 women aged <40 years with stage I ovarian cancer have been treated with conservative surgery, suggests the poss ibility of some extension of the traditional conservative approach to patients with unfavorable prognostic factors. Regarding the choice of an optimal postsurgical approach, experience to date has been disappoi nting. Only cisplatin has shown some promise as an adjuvant treatment of early disease. In an Italian study cisplatin treatment was associat ed with improved disease-free survival but there was no difference in overall survival when compared with both observation and P-32 treatmen t. These results suggested the design of a currently ongoing multicent er trial testing platinum-based therapy soon after surgery or at time of relapse.