Clinical and Translational Oncology

, Volume 9, Issue 5, pp 308–316

Treatment guidelines in ovarian cancer

  • A. Poveda Velasco
  • A. Casado Herráez
  • A. Cervantes Ruipérez
  • D. Gallardo Rincón
  • E. García García
  • A. González Martín
  • G. López García
  • C. Mendiola Fernández
  • B. Ojeda González
Special Article


National and international specialists have met with the aim of writing down the guidelines for the treatment of epithelial ovarian cancer (in the Spanish Castilian language). These guidelines are based on the International Consensus that was published in English in the Annals of Oncology in 2005. This condition is the leading cause of death from gynaecological cancer in western countries. Its low rate of survival, barely 30% at 5 years, is above all due to late diagnosis and inappropriate surgery, so emphasis is put on these aspects. After describing the methodology for early detection and a scheme of surgical diagnostic procedures in view of the staging of an ovarian mass, the following therapeutic strategies will be recommended: cytoreductive surgery together with platinum chemotherapy under normal conditions, and also in the case of relapse. Likewise, very recent models of treatment focused on molecular targets are presented, and a broad section on methodology of clinical assays. As for this, co-operation among groups is crucial in order to make the conclusions of these studies valid for the development of new therapies.

Key words

Ovarian cancer Treatment guidelines Adjuvant chemotherapy Surgical procedures 


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  1. 1.
    du Bois A, Quinn M, Thigpen T et al (2005) Consensus statements on the management of ovarian cancer — Final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Ann Oncol 16[Suppl 8]:7–12Google Scholar
  2. 2.
    Poveda A (2005) Ovarian cancer: is the news good enough? Int J Gynecol Cancer 15[Suppl 3]:298–306PubMedCrossRefGoogle Scholar
  3. 3.
    Menon U, Jacobs IJ (2000) Tumour markers and screening. In: Berek J, Hacker N (eds) Practical gynecologic oncology, 3rd Edn. Lippincott Williams & Wilkins, Philadelphia, pp 39–58Google Scholar
  4. 4.
    Skates S, Jacobs I, Knapp R (1998) Quantifying risk of ovarian cancer using longitudinal CA125 levels. In: Sharp F (ed.) Ovarian cancer 5. Isis Medical Media, Oxford, pp 187–197Google Scholar
  5. 5.
    Menon U, Talaat A, Jeyerajah AR et al (1999) Ultrasound assessment of ovarian cancer risk in postmenopausal women with CA125 elevation. Br J Cancer 80:1644–1647PubMedCrossRefGoogle Scholar
  6. 6.
    Menon U, Jacobs IJ (2000) Ovarian cancer screening in the general population. Ultrasound Obstet Gynecol 15:350–353PubMedCrossRefGoogle Scholar
  7. 7.
    Bast RC Jr, Badgwell D, Lu Z et al (2005) New tumor markers: CA125 and beyond. Int J Gynecol Cancer 15[Suppl 3]:274–281PubMedCrossRefGoogle Scholar
  8. 8.
    Boyce EA, Kohn EC (2005) Ovarian cancer in the proteomics era: diagnosis, prognosis and therapeutics targets. Int J Gynecol Cancer 15[Suppl 3]:266–273PubMedCrossRefGoogle Scholar
  9. 9.
    Boyd J (2001) Molecular genetics of hereditary ovarian cancer. In: Rubin SC, Sutton GP (eds) Ovarian cancer, 2nd Edn. Lippincott Williams and Wilkins, Philadelphia, pp 3–17Google Scholar
  10. 10.
    van Nagell JR Jr, DePriest PD, Reedy MB et al (2000) The efficacy of transvaginal sonographic screening in asymptomatic women at risk for ovarian cancer. Gynecol Oncol 77:350–356PubMedCrossRefGoogle Scholar
  11. 11.
    International Collaborative Ovarian Neoplasm (ICON) Collaborators (2003) International Collaborative Ovarian Neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst 95:125–132Google Scholar
  12. 12.
    Trimbos JB, Vergote I, Bolis G et al (2003) Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organization for Research and Treatment of Cancer — Adjuvant Chemotherapy in Ovarian Neoplasm Trial. J Natl Cancer Inst 95:113–125PubMedCrossRefGoogle Scholar
  13. 13.
    ICON 1 and EORTC-ACTION Collaborators (2003) International Collaborative Ovarian Neoplasm trial 1 and Adjuvant ChemoTherapy in Ovarian Neoplasm trial: two parallel randomized phase III trials of adjuvant chemotherapy in patients with early-stage ovarian carcinoma. J Natl Cancer Inst 95:105–112CrossRefGoogle Scholar
  14. 14.
    Bell J, Brady M, Lage J et al (2003) A randomized trial of three versus six cycles of carboplatin and paclitaxel as adjuvant treatment in early stage ovarian epithelial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 88:156CrossRefGoogle Scholar
  15. 15.
    Young RC, Walton LA, Ellenberg SS et al (1990) Adjuvant therapy in stage I and stage II epithelial ovarian cancer. Results of two prospective randomized trials. N Engl J Med 322: 1021–1027PubMedCrossRefGoogle Scholar
  16. 16.
    Berek JS, Bertelsen K, duBois A et al (1999) Advanced epithelial ovarian cancer: 1998 consensus statements. Ann Oncol 10[Suppl 1]:87–92PubMedCrossRefGoogle Scholar
  17. 17.
    Ozols RF (2000) Optimum chemotherapy for ovarian cancer. Int J Gynecol Cancer 10[Suppl 1]:33–37PubMedCrossRefGoogle Scholar
  18. 18.
    Poveda A (2003) Ovarian cancer treatment: what is new. Int J Gynecol Cancer 13[Suppl 2]:241–250PubMedCrossRefGoogle Scholar
  19. 19.
    Thigpen T, Stuart G, duBois A et al (2005) Clinical trials in ovarian carcinoma: requirements for standard approaches and regimens. Ann Oncol 16[Suppl 8]:13–19Google Scholar
  20. 20.
    Armstrong D, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34–43PubMedCrossRefGoogle Scholar
  21. 21.
    McGuire WP, Hoskins WJ, Brady MF et al (1996) Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and IV ovarian cancer. N Engl J Med 334:1–6PubMedCrossRefGoogle Scholar
  22. 22.
    Piccart M, Bertelsen K, James K et al (2000) Randomized intergroup trial of cisplatin-paclitaxel vs cisplatin-cyclophosphamide in women with advanced epithelial ovarian cancer. J Natl Cancer Inst 92:699–708PubMedCrossRefGoogle Scholar
  23. 23.
    Piccart M, Bertelsen K, Stuart G et al (2003) Long-term follow-up confirms a survival advantage of the paclitaxel-cisplatin regimen over the cyclophosphamide-cisplatin combination in advanced ovarian cancer. Int J Gynecol Cancer 13[Suppl 2]:144–148PubMedCrossRefGoogle Scholar
  24. 24.
    McGuire WP (2000) Confirmation of the “old” standard of care for ovarian cancer and a challenge. J Natl Cancer Inst 92:674–675PubMedCrossRefGoogle Scholar
  25. 25.
    Adams M, Calvert AH, Carmichael J et al (1998) Chemotherapy for advanced ovarian cancer — a consensus statement on standard practice. Br J Cancer 78:1404–1406. Erratum in: Br J Cancer 1999;79:690PubMedGoogle Scholar
  26. 26.
    Ozols RF, Bundy BN, Greer BE et al (2003) Phase III of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimal resected stage III ovarian cancer. A Gynecologic Oncology Group study. J Clin Oncol 21:3194–3200PubMedCrossRefGoogle Scholar
  27. 27.
    DuBois A, Lueck HJ, Meier W et al (2003) A randomized trial of cisplatin/paclitaxel vs carboplatin/paclitaxel as first-line treatment in ovarian cancer. J Natl Cancer Inst 95:1320–1329Google Scholar
  28. 28.
    Neijt JP, Engelholm SA, Tuxen MK et al (2000) Exploratory phase III study of paclitaxel and cisplatin versus paclitaxel and carboplatin in advanced ovarian cancer. J Clin Oncol 18:3084–3092PubMedGoogle Scholar
  29. 29.
    Vasey PA, Jayson GC, Gordon A et al (2004) Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. J Natl Cancer Inst 96:1682–1691PubMedCrossRefGoogle Scholar
  30. 30.
    Vergote I, Rustin GJ, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors [ovarian cancer]. J Natl Cancer Inst 92:1534–1535PubMedCrossRefGoogle Scholar
  31. 31.
    Pfisterer J, Harter P, Canzler U et al (2005) The role of surgery in recurrent ovarian cancer. Int J Gynecol Cancer 15[Suppl 3]:195–198PubMedCrossRefGoogle Scholar
  32. 32.
    Eisenkop SM, Friedman RL, Spirtos NM (2000) The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 88:144–153PubMedCrossRefGoogle Scholar
  33. 33.
    Markman M, Rothman R, Hakes T et al (1991) Second line platinum therapy in patients with ovarian cancer previously treated with cisplatin. J Clin Oncol 9:389–393PubMedGoogle Scholar
  34. 34.
    Thigpen JT, Vance RB, Khansur T (1993) Second-line chemotherapy for recurrent carcinoma of the ovary. Cancer 71[4 Suppl]:1559–1564PubMedGoogle Scholar
  35. 35.
    Eisenhauer EA, Vermorken JB, van Glabbeke M (1997) Predictors of response to subsequent chemotherapy in platinum pretreated ovarian cancer: a multivariate analysis of 704 patients. Ann Oncol 8:963–968PubMedCrossRefGoogle Scholar
  36. 36.
    The ICON and AGO Collaborators (2003) Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet 361:2099–2106CrossRefGoogle Scholar
  37. 37.
    González-Martín AJ, Calvo E, Bover I et al (2005) Randomised phase II trial of carboplatin versus paclitaxel-carboplatin in platinum-sensitive recurrent advanced ovarian carcinoma: a GEICO (Grupo Espanol de Invertigacion en Cancer de Ovario) study. Ann Oncol 16:749–755PubMedCrossRefGoogle Scholar
  38. 38.
    Pfisterer J, Plante M, Vergote I et al (2004) Gemcitabine/carboplatin vs carboplatin in platinum sensitive recurrent ovarian cancer. Results of a Gynecologic Cancer Intergroup randomized phase III trial of the AGO OVAR, the NCIC CTG and the EORTC GCG. 2004 ASCO Annual Meeting Proceedings. J Clin Oncol 22[14S Suppl]: 5005Google Scholar
  39. 39.
    Markman M, Kennedy A, Webster K et al (1999) Clinical features of hypersensitivity reactions to carboplatin. J Clin Oncol 17:1141Google Scholar
  40. 40.
    Lee CW, Matulonis UA, Castells MC (2005) Rapid inpatient/outpatient desensitization for chemotherapy hypersensitivity: standard protocol effective in 57 patients for 255 courses. Gynecol Oncol 99:393–399PubMedCrossRefGoogle Scholar
  41. 41.
    ten Bokkel Huinink W, Gore M, Carmichael J et al (1997) Topotecan versus paclitaxel for the treatment of recurrent epithelial ovarian cancer. J Clin Oncol 15:2183–2193PubMedGoogle Scholar
  42. 42.
    Gordon AN, Fleagle JT, Guthrie D et al (2001) Recurrent epithelial ovarian carcinoma: a randomised phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 19:3312–3322PubMedGoogle Scholar
  43. 43.
    Piccart MJ, Green JA, Lacave AJ et al (2000) Oxaliplatin or paclitaxel in patients with platinum pretreated advanced ovarian cancer: A randomised phase II study of the European Organization for Research and Treatment of Cancer Gynecology Group. J Clin Oncol 18:1193–1202PubMedGoogle Scholar
  44. 44.
    Vermorken J, Gore M, Perren T et al (2001) Multicenter randomized phase II study of oxaliplatin or topotecan in platinum-pretreated epithelial ovarian cancer patients. Proc Am Soc Clin Oncol 20:212aGoogle Scholar
  45. 45.
    Rosenberg P, Anderson H, Boman K et al (1999) A randomised multicenter study of single agent paclitaxel given weekly versus every three weeks to patients with ovarian cancer previously treated with platinum therapy. Proc Am Soc Clin Oncol 18:368aGoogle Scholar
  46. 46.
    O’Byrne KJ, Bliss P, Grahan JD et al (2002) A phase III study of doxil/caelyx versus paclitaxel in platinum-treated, taxane-naive relapsed ovarian carcinoma. Proc Am Soc Clin Oncol 21:203aGoogle Scholar
  47. 47.
    González Martín A (2005) Treatment of recurrent disease: randomized trials of monotherapy versus combination chemotherapy. Int J Gynecol Cancer 15[Suppl 3]:241–246PubMedCrossRefGoogle Scholar
  48. 48.
    Cannistra SA (2006) Intraperitoneal chemotherapy comes of age. N Engl J Med 345:77–79CrossRefGoogle Scholar
  49. 49.
    Alberts DS, Liu PY, Hannigan EV et al (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335:1950–1955PubMedCrossRefGoogle Scholar
  50. 50.
    Markman M, Bundy BN, Alberts DS et al (2001) Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 19: 1001–1007PubMedGoogle Scholar
  51. 51.
    Walker JL, Armstrong D, Huang HQ et al (2006) Intraperitoneal catheter outcomes in a phase III trial of intravenous versus intraperitoneal chemotherapy in optimal stage III ovarian and primary peritoneal cancer: a Gynecologic Oncology Group Study. Gynecol Oncol 100:27–32PubMedCrossRefGoogle Scholar
  52. 52.
    Markman M, Walker JL (2006) Intraperitoneal chemotherapy of ovarian cancer: a review, with a focus on practical aspects of treatment. J Clin Oncol 24:1–7CrossRefGoogle Scholar
  53. 53.
    Vergote I, De Brabanter J, Fyles A et al (2001) Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357:176–182PubMedCrossRefGoogle Scholar
  54. 54.
    Zanetta G, Rota S, Chairi S et al (1998) The accuracy of staging: an important prognostic determinate in stage I ovarian carcinoma. A multivariate analysis. Ann Oncol 9:1097–1101Google Scholar
  55. 55.
    Eisenhauer EA, Gore M, Neijt JP (1999) Ovarian cancer: should we be managing patients with good and bad prognostic factors in the same manner? Ann Oncol 10[Suppl 1]:S9–S15CrossRefGoogle Scholar
  56. 56.
    Tropé C, Kaern J, Hogberg T et al (2000) Randomized study on adjuvant chemotherapy in stage I high-risk ovarian cancer with evaluation of DNA-ploidy as prognostic instrument. Ann Oncol 11:281–288PubMedCrossRefGoogle Scholar
  57. 57.
    Hoskins WJ, Bundy BN, Thigpen JT et al (1992) The influence of cytoreductive surgery on recurrence free interval and survival in small volume stage III epithelial ovarian cancer: a Gynecologic Oncology Group study. Gynecol Oncol 47:159–166PubMedCrossRefGoogle Scholar
  58. 58.
    Hoskins WJ, McGuire WJ, Brady MF et al (1994) The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma. Am J Obstet Gynecol 170:974–980PubMedGoogle Scholar

Copyright information

© Feseo 2007

Authors and Affiliations

  • A. Poveda Velasco
    • 1
  • A. Casado Herráez
    • 2
  • A. Cervantes Ruipérez
    • 3
  • D. Gallardo Rincón
    • 4
  • E. García García
    • 1
  • A. González Martín
    • 5
  • G. López García
    • 6
  • C. Mendiola Fernández
    • 7
  • B. Ojeda González
    • 8
  1. 1.Servicio de Oncología MédicaFundación Instituto Valenciano de OncologíaValenciaSpain
  2. 2.Servicio de Oncología MédicaHospital Universitario San CarlosMadridSpain
  3. 3.Servicio de Hematología y Oncología MédicaHospital Clínico Universitario de ValenciaValenciaSpain
  4. 4.Instituto Nacional de CancerologíaMéxico DFMéxico
  5. 5.Servicio de Oncología MédicaHospital Ramón y CajalMadridSpain
  6. 6.Clínica Universitaria de NavarraPamplona, NavarraSpain
  7. 7.Servicio de Oncología MédicaHospital Universitario 12 de OctubreMadridSpain
  8. 8.Servicio de Oncología MédicaHospital de la Santa Creu i Sant PauBarcelonaSpain

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