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Ovarian Cancer

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Drs. Randall and Rubin address three subjects important to all patients with advanced-stage epithelial ovarian cancer: (1) the incidence and annual mortality associated with the disease, (2) the use of intestinal surgery at the time of initial surgery, and (3) the use of surgery for intestinal obstruction in patients with recurrent (or progressive) ovarian cancer. I believe that progress in all three areas has been made, albeit slowly.

In their excellent review of intestinal obstruction in women with advanced and recurrent ovarian cancer, Drs. Randall and Rubin indicate that median survivals and quality of life for these patients have improved substantially. Data from the International Federation of Obstetrics and Gynecology (FIGO)[1] and the National Cancer Institute’s Survival, Epidemiology, and End Results (SEER) program[2] indicate that the 5-year disease-free survival for advanced-stage disease has risen over the past several decades from approximately 5% to 20%. Therefore, the palliation of intestinal obstruction secondary to metastatic ovarian cancer has become a more urgent issue. The management of recurrent or chronic intestinal obstruction is often complex, and the authors have carefully substantiated issues related to this complication of the malignancy.

ASCO-Although paclitaxel (Tax-ol) plus cisplatin (Platinol) as initial therapy for ovarian cancer cost a good deal more than cyclophosphamide plus cisplatin, it is cost-effective by the usually accepted guidelines, said Hugh Walker, PhD, a health economist at the National Cancer Institute of Canada’s Clinical Trials Unit, Kingston, Ontario.

ASCO-In contrast to many recent studies, the ICON3 trial finds that paclitaxel (Taxol) plus carboplatin (Paraplatin) is no more effective than other chemotherapy regimens as first-line therapy of ovarian cancer. ICON3-the Third International Collaborative Ovarian Neoplasm study-is an international multicenter trial involving 2,074 women with newly diagnosed ovarian cancer requiring chemotherapy.

SAN DIEGO-Conservative surgery can preserve fertility in young women with epithelial ovarian cancer and achieve survival rates comparable to standard surgery (total abdominal hysterectomy and removal of the fallopian tubes and ovaries), researchers from Memorial Sloan-Kettering Cancer Center reported at the 31st annual meeting of the Society of Gynecologic Oncologists (SGO).

SAN DIEGO-Most women with ovarian cancer have previous abdominal or gastrointestinal (GI) complaints, and diagnoses are often delayed because neither patients nor physicians recognize these early warning signs, Barbara A. Goff, MD, reported at the 31st Annual Meeting of the Society of Gynecologic Oncologists (SGO).

SAN DIEGO-Preliminary data show that a new outcomes measurement tool developed by the Society of Gynecologic Oncologists (SGO) Outcomes Task Force is a reliable method for demonstrating quality of care to third parties. Lead author Alexander W. Kennedy, MD, of the Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, reported on behalf of the task force at the SGO’s 31st Annual Meeting.

The borderline category of ovarian tumors is one of the most controversial topics in gynecologic oncology and pathology, and is confusing to both clinicians and patients. Although numerous reviews have appeared in the literature, most of them rehash the prevailing views on borderline tumors without critically evaluating the published data that allegedly validate some rather puzzling and perplexing notions. For example, although these tumors are considered to be a subset of carcinoma, most patients are cured even when they have “metastatic” disease that has been inadequately treated. In addition, reports cite recurrence and death as late as 39 years after the diagnosis of tumors that appear histologically bland and noninvasive.

Ovarian tumors of low malignant potential (LMP) would benefit from a new name, not to mention a deeper understanding of their biology, effective treatment, and a framework within which they can be studied. Fortunately, for a pathologic entity that is poorly understood and also is unresponsive to current therapy, most LMP ovarian tumors carry a benign prognosis.

WASHINGTON-All cancer patients should have the opportunity to participate in clinical trials, something that will occur only if Congress passes pending legislation to guarantee insurance coverage for the cost of routine patient care for study participants, speakers told a Capitol Hill briefing sponsored by the American Society of Clinical Oncology (ASCO).