the upper limit of normal on 2 occasions separated
by at least 1 week. For patients with initially elevated levels of CA-125 that did not normalize following
treatment, progression is defined as a CA-125 level
2 times greater than the nadir following treatment.
In patients with suspected recurrence, a CT scan
should also be considered to assess for the presence of visible disease. However, the sensitivity of
CT in some studies has been shown to be as low
as 40%, and the use of positron-emission tomog-raphy/CT has shown high sensitivity and positive
predictive value in diagnosing macroscopic recurrent disease in the setting of equivocal findings on
CASE PATIENT CONCLUSION
After completing chemotherapy, the patient be-
gins the routine alternating schedule of follow-up be-
tween gynecologic surgery and medical oncology
every 3 months for 2 years and then every 6 months
for a total of 5 years, with the CA-125 checked at
each visit. She also sees a genetics specialist as
recommended by the NCCN guidelines, and BRCA
testing is negative for mutation. At the completion of
her 5 years of follow-up, her CA-125 remains at 22
U/mL and she is without gastrointestinal or pelvic
symptoms. She is then referred back to her local
gynecologist for long-term follow-up.
Based on early clinical trials, the benefit of surgery and chemotherapy has been established in
the management of ovarian carcinoma. In addition
to this standard, the issues of screening and maintenance are topics still undergoing study.
1. American Cancer Society. Cancer Facts & Figures 2015.
document/acspc-044510.pdf. Accessed March 12, 2015.
2. GLOBOCAN 2012 v1.2, Cancer Incidence and Mortality
Worldwide. IARC Cancerbase [Internet] Lyon, France: International Agency for Research on Cancer, 2012. http://globo-
can.iarc.fr//factsheets/cancer/all. Accessed March 6, 2015.
3. Raja FA, Chopra N, Ledermann JA. Optimal first-line treatment of ovarian cancer. Ann Oncol 2012;23(suppl 10):
4. Crum CP, Drapkin R, Kindelberger D, et al. Lessons from
Test your knowledge of this topic.
Go to www.turner-white.com and select Oncology
from the drop-down menu of specialties.
Trial Treatment Outcomes
Bell et al 200686
Paclitaxel/carboplatin 3 vs 6 cycles 5-yr DFS for 3 vs 6 cycles was 75% and 80%
5-yr OS for 3 vs 6 cycles was 81% and 83%
Chan et al 201087
Subgroup analysis 5-yr DFS for 3 vs 6 cycles were 60% and 83%
(P = 0.007)
Hazard ratio for serous tumor having 6 cycles = 0.33
(P = 0.04)
Mannel et al 201188
Paclitaxel/carboplatin for 3 cycles in both arms, then
weekly paclitaxel for 24 wk vs observation
5-yr survival of 85.4% for maintenance paclitaxel vs
86.2% for observation
DFS = disease-free survival; OS = overall survival.
Adapted from Tangjitgamol S, Kavanagh, J. Cytotoxic trials by the Gynecologic Oncology Group. http://www.esgo.org/Education/PublishingIm-
ages/131.pdf. Accessed March 5, 2015.