Salvage therapy for ovarian cancer.

Patients with epithelial ovarian cancer must receive optimal surgical care and state-of-the-art chemotherapy in the primary treatment setting. The salvage treatment of women with recurrent or persistent ovarian cancer remains a difficult task. A very small percentage of patients with platinum-sensitive, small-volume disease appear to achieve prolonged disease-free survival. The treatment of patients with larger-volume disease (> 0.5 cm) or platinum-resistant disease remains largely palliative. The plethora of available new agents has provided the physician with multiple options for salvage chemotherapy. Although cure in the salvage setting is not often achieved currently, palliative treatment allows many patients to live painfree, productive lives. Candidates for salvage therapy may be grouped into one of several categories, which reflect different prognoses for response. These categories include refractory disease (defined as progressive tumor during primary treatment), persistent disease (a partial response to primary therapy followed by elevated tumor markers or clinically evident persistent disease), and recurrent disease (initial complete response to primary therapy with subsequent relapse). Categorizing patients into these categories provides a systematic method for organizing the administration of salvage chemotherapy.