Treatment of progressive and recurrent ovarian cancer

Secondary surgery after failure of primary treatment is a promising and rea sonable option only for patients with a relapse-free interval of at least 6 -12 months who should have ideally achieved a tumor-free status after prima ry therapy. As after primary surgery, size of residual tumor is the most si gnificant predictor of survival after secondary surgery. Even in the case o f multiple tumor sites, complete removal of the tumor can be achieved in ne arly 30% of the patients. Treatment results are much better in specialized oncology centers with optimal interdisciplinary cooperation compared with s maller institutions. Chemotherapy can be used both for consolidation after successful secondary surgery and for palliation in patients with inoperable recurrent disease. Since paclitaxel has been integrated into first-line ch emotherapy, there is no defined standard for second-line chemotherapy. Seve ral cytotoxic agents have shown moderate activity in this setting, includin g treosulfan, epirubicin, and newer agents such as topotecan, gemcitabine, vinorelbine, and PEG(polyethylene glycol)-liposomal doxorubicin. Thus, the German Arbeitsgemeinschaft Gynakologische Onkologie (AGO) has initiated sev eral randomized studies in patients with recurrent ovarian cancer in order to define new standards for second-line chemotherapy.