Despite optimal treatment (complete cytoreduction and adjuvant chemotherapy), 5-year survival for advanced ovarian cancer is approximately 30% and most patients succumb to their disease. Cytoreductive surgery is accepted as a major treatment of primary ovarian cancer but its role in recurrent disease is controversial and remains a field of discussion mainly owing to missing data from prospective randomized trials. A critical review of literature evidence on secondary surgery in recurrent ovarian cancer will be described. 1. Introduction Despite optimal treatment (complete cytoreduction and adjuvant platinum-paclitaxel chemotherapy), 5-year survival for advanced ovarian cancer is approximately 30% [1] and most patients succumb to their disease. Overall, 85% of ovarian cancer patients will experience recurrent disease, with virtually no long-term survival after recurrence. Cytoreductive surgery is accepted as a major treatment of primary ovarian cancer but its role in recurrent disease is controversial and remains a field of discussion mainly owing to missing data from prospective randomized trials and to the broad variety of definitions of surgical procedures. Moreover, different studies include different groups of patients ranging from patients with persistent disease at the end of first line treatment (which possibly includes patients with persisting and/or progressing disease at the completion of carboplatin-paclitaxel chemotherapy) to patients with recurrent disease after a disease-free period variable from some weeks to several years [2, 3]. In addition, all but one series are represented by retrospective studies and obviously suffer from selection bias. Generally, the rate of patients not offered secondary surgery at recurrence varied from 7 to 64% among different trials but unfortunately informations about selection criteria and outcomes of nonsurgery selected populations are lacking. Moreover, given the long time span of most studies (>5–10 years), the pre- and postoperative chemotherapy treatments varied widely between patients thus increasing the difficulties in the interpretation of data. None of the studies details how recurrence was detected, the type of followup adopted after primary treatment, and the selection criteria used for secondary cytoreduction which broadly differ between studies. Although the recently published MRC OVO5/EORTC 55955 trial [4] concluded that early intervention with chemotherapy for recurrent ovarian cancer detected only on the basis of serum CA 125 rising does not alter overall survival with respect to waiting for
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