OVARIAN CANCER TREATMENT OPTIONS
The choice of treatment for ovarian cancer depends largely on the type of cancer as well as the stage and grade of the disease. Other factors that can play a part in choosing the best treatment plan for ovarian cancer may include your general state of health, whether you plan to have children, and other personal factors.
Advances in the treatment and early detection of ovarian cancer have led to gains in 5-year survival rates but although approximately 10%-15% of patients achieve and maintain complete responses to therapy, the remaining patients have persistent disease or eventually relapse. These patients will generally undergo a series of treatments, each associated with progressively shorter treatment-free intervals. Median survival of patients with recurrent ovarian cancer ranges from 12-24 months, demonstrating the chronic natural history of the disease.
CURRENT TREATMENTS FOR OVARIAN CANCER
Currently, the most prevalent treatments for ovarian cancer are surgery and chemotherapy. Hormonal therapy and immunologic therapy are also sometimes used. And in some cases, two or even all of these treatments are recommended. Radiation therapy is sometimes used to treat pain in patients with advanced disease. Visit the National Comprehensive Cancer Network for additional information about the above treatments for ovarian cancer.
THE IMPORTANCE OF SURGERY BY GYNOCOLOGIC ONCOLOGISTS
The Society of Surgical Oncology has offered the following guidelines for ovarian cancer surgery:
"Surgeons undertaking operations for possible ovarian cancer should have both the necessary technical expertise and a thorough understanding of the management of the disease itself...optimal treatment of this disease requires the skillful and appropriate integration of cancer surgery and chemotherapy, and is best carried out in centers in which an experienced and coordinated multidisciplinary team is available".
While accessibility to these surgical sub-specialists has gradually increased for women with suspected ovarian cancer, the proportion of ovarian cancer patients initially operated on by gynecologic oncologists remains below 50%. Evaluating (6,885) patients with stage III or IV ovarian carcinoma, Dr. Robert Bristow et al showed that consistent referral of patients with apparent advanced ovarian cancer to expert centers for primary surgery may be the best means currently available for improving overall survival. Even with the use of platinum based chemotherapy, maximal cytoreduction was one of the most powerful determinants of cohort survival among patients with stage III or IV ovarian carcinoma and was associated with a 50% increase of actuarial survival.
FUTURE DIRECTIONS: SHIFT TO A CHRONIC LONG-TERM APPROACH TO DISEASE MANAGEMENT
Advances in the treatment of ovarian cancer over the past decade have led to these improvements and have prompted oncologists to now view the management of patients with ovarian cancer as an ongoing, long-term challenge. This shift in approach has raised important new questions regarding patient management, including:
- Recognition that the overtreatment of patients early in the disease process may adversely affect future treatment opportunities
- The need to define trigger points for initiating or changing treatment (e.g., sequential increases in serum cancer antigen 125 (CA125) levels, appearance of symptoms, or cumulative toxicities) and anticipation of impending treatment decision points
- A renewed emphasis on patient education and participation in decision-making.(1)
The ITI-OC research underway at the University of Pennsylvania has embraced a collaborative and long-term view of developing a successful treatment for ovarian cancer recognizing the increasingly chronic-nature of this disease. Learn more about the immune therapy ovarian cancer treatment clinical trials underway at the Abramson Cancer Center under the direction of Dr. George Coukos.
(1) http://www.ovariancancer.jhmi.edu/newsletter/winter2003/features.cfm#article2