Subsequent management

The majority of patients demonstrate a complete clinical response to initial debulking and chemotherapy with physical examination, CT scan and CA-125 levels all normal. But of these, about half still have disease as defined by negative biopsy specimens on a second look laparotomy.

The discovery of disease itself has little effect on survival so present day policy is to recommend second look laparotomy only if further treatment is to be considered. The guidelines for managing persistent disease are less established. Treatment options include:

• secondary debulking - not curative but may be valuable in certain cases. For example, patients with imminent bowel obstruction due to a single dominant pelvic mass; or whom have relapsed many years after initial therapy, and possibly, would enjoy a similar disease free period after another debulking.
  
  
• intraperitoneal chemotherapy - drugs such as cisplatin are administered into the peritoneal cavity through an indwelling catheter. Only effective if a substantial fraction of tumour cells remain chemosensitive.
  
  
• systemic treatment with drugs that are not cross- resistant to platinum. Taxol - paclitaxel - may induce a response in 25% of patients with platinum resistant disease.
  
  
• autologous bone marrow transplantation - to compensate for myeloblative chemotherapy. Patients must be aware of the risks of such procedures - currently, a 5-10% chance of treatment related death.

Whole abdomen radiotherapy seems to be ineffective.