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"Abstract:
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events........Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging."
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"Commentary:
CONTEXT AND CAVEATS
Prior knowledge
In the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm, 448 patients with early ovarian cancer were randomly assigned, after surgery, to adjuvant chemotherapy or to observation. After a median follow-up of 5.5 years, adjuvant chemotherapy was associated with improved recurrence-free survival but not overall survival. In a subgroup analysis, better recurrence-free and overall survival were observed among those with nonoptimal surgical staging than those with optimal staging.
Study design
Long-term analysis of data from this trial after a median of 10.1 years of follow-up.
Contribution
The long-term analysis supported most conclusions from the original analysis, except that overall survival after optimal surgical staging was improved, even among patients who received adjuvant chemotherapy. More cancer-specific deaths were observed among nonoptimally staged patients than among optimally staged patients.
Implications
Completeness of surgical staging among patients with early ovarian cancer was statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy was restricted to patients with nonoptimal surgical staging.
Limitations
The trial was not designed to compare different surgical staging procedures. Patients could not be prospectively stratified by surgical staging category. The study had a limited sample size. Quality of life was not studied."
From the Editors
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I'm not getting it Sandi....what is the specific significance of this study....chemo only helps late stage patients????
ReplyDeleteThese studies started about a decade ago with the ICON trials and therefore this 10 year followup. I have always professed that early stages of ovarian cancer, albeit low incident rates, require much more emphasis. Why? Because depending on the research paper, a high percentage of apparent early stage ovarian cancer women are under-staged. The key for early stage ovarian cancer women is: who benefits and who does not benefit from chemotherapy and how to improve survival. While this is obvious for all women with ovarian cancer, some women in the earliest stages of early ovarian cancer do not receive chemotherapy as the potential harm outweighs the potential benefit. Chemo helps early stage ovarian cancer women - but the research is attempting to address which early stages and which conditions. Bottom line? All women suspected of ovarian cancer deserve care under well known clinical practice guidelines.
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