CURRENT TREATMENT OF MALIGNANT OVARIAN EP ITHELIAL TUMORS

Surgery is the essential element of staging and treatment of malignant ovarian tumours. Regardless of the stage, it must include peritoneal cytology, hysterectomy with bilateral adnexectomy, omentectomy, pelvic and lumbo-aortic lymphadenectomy, appendicectomy and multiple periton eal biopsies. In stage I tumours, in young women desiring a subsequent pregnancy, preservation of the uterus and contralateral ovary can be proposed. In stages II, III and IV, the therapeutic strategy consists of primary surgery and systematic chemotherapy (6 cycles). Radical sur gery is essential in these cases, as the size of the residual tumour a t the end of operation constitutes the major prognostic factor. To opt imize the quality of tumour debulking, the maximum of visible carcinom atous nodules must be resected with, if necessary, gastrointestinal re sections. The value of second-look surgery, after 6 cycles of chemothe rapy, is currently controversial: it is only indicated in the context of randomized trials. Borderline malignant ovarian tumours have a good prognosis regardless of their stage. Surgery can very often be conser vative, particularly in young women. Adjuvant chemotherapy has been sh own to be effective in these rumours. Many studies are underway to def ine the value of new cytostatic molecules and ''interval'' surgery (in tercalated between several courses of chemotherapy).