ABSTRACT
Adjuvant chemotherapy most often involves the systemic administration of chemotherapeutic agents after the removal of the primary tumor, without evidence of residual tumor remains. This approach is based on data from 1950 to 1960, which noted an inverse relationship between response to chemotherapy and number of tumor cells. The possibility of improved survival in patients with minimal disease after surgery, coupled with a poorer response in advanced disease, provided a good rationale for the use of adjuvant chemotherapy. Early ovarian cancer signifies localized disease and is equivalent to FIGO stages IA, IB, and IC (sometimes also including stage IIA). A truly localized disease is curable by surgery. Two problems are encountered with regard to adjuvant therapy in early ovarian cancer (1) The first is to find prognostic factors that can predict the presence of micrometastasis (the disease is no longer localized), and the second is to find adjuvant therapies that are both effective in controlling micrometastatic disease and with tolerable short-term and long-term side effects. Patients with a significant statistical risk for having persistent disease will be treated with adjuvant therapy (Table 1). This means that only a fraction of the patient population treated actually has micrometastasic disease and could potentially benefit from the treatment. Therefore, the role of adjuvant treatment in patients with early epithelial ovarian cancer still is controversial. There is, however, little argument about the role of platinum-based chemotherapy after primary surgery in all patients with FIGO stage II disease (2).
