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Debate 5B - Should CA-125 Surveillance be Performed after Completion of Primary Treatment for Ovarian Cancer Patients in Remission?

No

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Rising CA-125 levels can detect relapsed ovarian cancer about six months before symptoms develop. Therefore, many asymptomatic patients have routine CA-125 measurements during follow-up. The only trial of CA-125 surveillance after first-line therapy randomized patients to early or delayed treatment after a doubling of CA-125 level. It showed those in the early arm had no survival benefit and worse quality of life. The trial was criticized as few patients had secondary surgery, yet randomized trials show conflicting results on the value surgery. Patients should be aware that recurrent ovarian cancer is not curable and require information on surveillance options.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2023

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References

Rustin, GJ, et al. Early versus delayed treatment of relapsed ovarian cancer (MRCOV05/EORTC 55955): a randomised trial. Lancet 2010;376:11551163.CrossRefGoogle ScholarPubMed
Krell, D, et al. Audit of CA-125 follow-up after first-line therapy for ovarian cancer. Int J Gynecol Cancer 2017;27:11181122.CrossRefGoogle ScholarPubMed
Esselen, KM, et al. Use of CA-125 tests and CT scans for surveillance in ovarian cancer. JAMA Oncol 2016;2(11):14271433.CrossRefGoogle ScholarPubMed
Coleman, RL, et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med 2019;381(20):19291939.CrossRefGoogle ScholarPubMed
Du Bois, A, et al. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: final analysis of AGO DESKTOP III/ENGOT-ov20. J Clin Oncol 2020;38(Suppl. 15):6000.CrossRefGoogle Scholar

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