Evaluation of follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment

Abstract

Background Ovarian cancer is the sixth most common cancer and seventh cause of cancer death in women worldwide. Traditionally, many patients who have been treated for cancer undergo long-term follow up in secondary care. Recently however it has been suggested that the use of routine review may not be effective in improving survival, quality of life (QoL), and relieving anxiety. In addition, it may not be cost effective. Objectives To compare the potential benefits of different strategies of follow up in women with epithelial ovarian cancer following completion of primary treatment. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010, Issue 4), MEDLINE and EMBASE (to November 2010). We also searched CINAHL, PsycLIT, registers of clinical trials, abstracts of scientific meetings, reference lists of review articles, and contacted experts in the field. Selection criteria All relevant randomised controlled trials (RCTs) that evaluated follow-up strategies for patients with epithelial ovarian cancer following completion of primary treatment. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Main results We found only one RCT (Rustin 2010) that met our inclusion criteria. This trial included 529 women and reported data on immediate treatment versus delayed treatment in women with confirmation of remission and with normal CA125 concentration and no radiological evidence of disease after surgery and first-line chemotherapy. Overall survival showed no significant difference between the immediate and delayed arms after a median follow up of 56.9 months (unadjusted hazard ratio (HR) = 0·98, 95% confidence interval (CI) 0·80 to 1·20; P = 0·85). Time from randomisation to first deterioration in global health score or death was significantly shorter in the early group compared with the delayed group (HR 0·71, 95% CI 0·58 to 0·88; P < 0·01). The trial was at low risk of bias. Authors’ conclusions There is a lack of randomised studies on most aspects of follow-up care after treatment for epithelial ovarian cancers. Limited evidence from a single trial suggests that routine surveillance with CA125 in asymptomatic patients, with treatment at CA125 relapse, does not seem to offer survival advantage when compared to treatment at symptomatic relapse. Randomised controlled trials are needed to compare different types of follow up on the outcomes of survival, quality of Life, cost and psychological effects.

Serum folate receptor alpha as a biomarker for ovarian cancer: Implications for diagnosis, prognosis and predicting its local tumor expression

“…This discordance between the two studies may be due to the different assay methods used for detecting sFRA, the size of our larger study or due to different patient populations, or a combination thereof. Our study demonstrated that sFRA levels were not elevated in ovarian metastasis from the colorectal cancer patients or endometriotic cysts which often exhibited elevated CA125, further indicating the specificity for sFRA in EOC. However, given the limited sample size for the metastasis from other tumors in this study, these data should be interpreted with caution but warrant further study.…”

Latest research and treatment of advanced-stage epithelial ovarian cancer

“…These biological or ‘chemical ‘ recurrence patients frequently have small-volume disease on surgical investigation; however, the value of treatment in the absence of symptoms has been strongly challenged. 55 A recent phase III study examined the role and impact of serial CA-125 surveillance. 56 In this study, 1,442 women in complete clinical remission following front-line therapy underwent CA-125 evaluation every 3 months.…”

The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials

“…The reported aim of regular follow-up is to allow detection of recurrent disease before symptoms develop, allowing earlier treatment with a possible improved outcome, as well as providing an opportunity to provide information and signal early and late consequences of treatment. For follow-up to be effective in this context, the management of recurrence must be amenable to an intervention which itself leads to an improved survival [10]. However, for many cancers, recurrences are not commonly identified in asymptomatic patients at follow-up consultations and most recurrences are reported as interval events [11].…”