Natural Medicine Update

STUDY: Women with early-stage ovarian cancer may do better if they receive chemotherapy immediately after undergoing surgery.

JOURNAL: Journal of the National Cancer Institute 2003;95:94-95,113-132

AUTHORS: Dr. Mahesh Parmar

ABSTRACT: Two large, newly released European studies suggest that women with early-stage ovarian cancer may do better if they receive chemotherapy immediately after undergoing surgery.

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COMMENTARY: Both studies found chemotherapy reduced the risk of a cancer recurrence. One found the treatment increased survival, but the other did not.

However, the studies are not the final word on the benefits of chemotherapy following surgery, said Dr. Debbie Saslow, of the American Cancer Society, who was not involved in either study.

"Women still need to discuss their particular situations with their doctors and decide about which course of treatment may be best for them."

Currently, women diagnosed with early-stage ovarian cancer tend to have surgery and if the cancer comes back, additional surgery and chemotherapy are recommended, according to Saslow, director of breast and gynecologic cancer at the American Cancer Society. In about 50% of cases, women with early-stage cancer experience a relapse after surgery.

Previous studies have shown that some women with early-stage ovarian cancer can be cured by surgery alone and therefore can avoid the devastating side effects of chemotherapy.

One important factor is to determine how far the disease has progressed so an informed decision can be made, Slaslow explained.

In the first study, the International Collaborative Ovarian Neoplasm Collaborators led by Dr. Mahesh Parmar of the Medical Research Council Clinical Trials Unit in London, England looked at 477 women who either had chemotherapy after surgery or had surgery alone.

After five years, women who received chemotherapy had a 9% greater overall survival (79% versus 70%) and an 11% greater chance of not having a recurrence of their cancer (73% versus 62%), according to the report published in the January 15th issue of the Journal of the National Cancer Institute.

In the second study, 448 women with early-stage ovarian cancer had either chemotherapy and surgery or had surgery alone.

In this study, after 5.5 years no difference in overall survival was detected between the two groups of women. However, women who got chemotherapy were less likely to have their cancer come back, according to the study's lead author, Dr. J. Baptist Trimbos of Leiden University Medical Center in The Netherlands and colleagues.

Overall, 76% of patients treated with chemotherapy were recurrence-free compared with 68% of patients not treated with chemotherapy.

The trials included a mix of patients, some with a poor prognosis and others with a better prognosis, based on the types of tumors they had. The studies do not help determine which women can be spared chemotherapy.

More research needs to be conducted to better identify women "who do not require additional therapy, while also seeking to improve therapy in patients who do."