Adjuvant (post-surgery) chemotherapy for early stage ovarian cancer
Evidence SummariesLevel of Evidence = A
Adjuvant platinum-based chemotherapy prolongs the survival of patients with early stage (FIGO stage I/IIa) epithelial ovarian cancer.
A Cochrane review 1 included 5 studies with a total of 1277 patients with early stage epithelial ovarian cancer. Follow-up time was 46 to 121 months. Adjuvant, post-operative cisplatin-based chemotherapy was used in 4 of the trials; one trial used melphalan. Meta-analysis of 3 trials (1008 women) indicated that women who received adjuvant platinum-based chemotherapy had better overall survival (OS) than those who did not (HR 0.71; 95% CI 0.53 to 0.93). Likewise, meta-analysis of 4 trials (1170 women) indicated that women who received adjuvant chemotherapy had better progression-free survival (PFS) (HR 0.67; 95% CI 0.53 to 0.84). Findings were robust over time: with 10-year HR estimates of 0.72 (95% CI 0.57 to 0.92; 2 trials, n=925 women) and 0.67 (95% CI 0.53 to 0.83;2 trials, n=925 women) for overall survival and progression-free survival, respectively (high quality evidence).
Sub-group analysis suggested that women who had optimal surgical staging of their disease were unlikely to benefit from adjuvant chemotherapy (HR for OS 1.22; 95% CI 0.63 to 2.37), whereas those who had sub-optimal staging did (HR for OS 0.63; 95% CI 0.46 to 0.85). One trial showed a benefit from adjuvant chemotherapy among women at high risk (HR for OS 0.48; 95% CI 0.32 to 0.72) but not among those at low risk (HR for OS 0.95; 95% CI 0.54 to 1.66). The limitation of the benefits of chemotherapy to sub-optimally staged patients together with the finding in one trial of the benefit for the women with high-risk cancer suggests that the real value of adjuvant chemotherapy is in the treatment of occult advanced stage disease.
Comment: Subgroup findings could be due to chance and should be interpreted with caution.
1. Winter-Roach BA, Kitchener HC, Dickinson HO. Adjuvant (post-surgery) chemotherapy for early stage epithelial ovarian cancer. Cochrane Database Syst Rev 2012 March:CD004706 [Assessed as up-to-date: 24 March 2015]. [PMID:19588360]
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