In order to evaluate the effect of adjuvant chemotherapy and surgical staging in early ovarian cancer patients, the European Organisation for Research and Treatment of Cancer - Gynecologic Cancer Group (EORTC-GCG) performed the Adjuvant ChemoTherapy in Ovarian Neoplasm (ACTION) trial (EORTC trial 55904). The ACTION trial was a randomized study on the role of platinum containing adjuvant chemotherapy in early ovarian cancer patients with FIGO stages Ia and Ib (grade II-III) and stages Ic and IIa (grade I-III) and all stages Ia-IIa clear cell carcinoma after surgery. Randomization between platinum containing chemotherapy and no adjuvant treatment took place after surgical staging and patients randomized to receive platinum based chemotherapy were treated within four weeks after surgical treatment for at least four consecutive courses. Because there still exist a lot of discussion and questions about the treatment and prognosis of patients with early ovarian cancer, we further examined the surgical staging categories and the different subgroups in order to get some answers on these subjects. In chapter 2 the results of the first analysis of the ACTION trial are described between the adjuvant chemotherapy arm and the no treatment arm (observation arm) on the role of platinum-based chemotherapy on disease-free survival (DFS) and overall survival (OS). Furthermore, analyses were performed in optimally staged patients versus nonoptimally staged patients. A review of the treatment modalities and recent findings in early ovarian cancer patients is given in chapter 3. The clinical characteristics and response to platinum-based chemotherapy in patients with clear cell carcinoma (CCC) versus serous adenocarcinoma (SAC) randomized in the ACTION trial are described in chapter 4. Early ovarian cancer patients are often incompletely staged during their initial surgery. In chapter 5 we discuss the possible reasons for inadequately staging early ovarian cancer patients. The effect of lymph node sampling and taking of blind biopsies as part of the surgical staging procedure for early ovarian cancer on DFS and OS in patients who received no adjuvant chemotherapy are analysed in chapter 6.In chapter 7 the prognostic value of the FIGO Ic substages including capsule rupturing, ascites containing malignant cells, surface tumor and positive peritoneal fluid in relation to disease-free and overall survival are described. Finally we show the long term results of the patients randomized in the ACTION trial in chapter 8.UBL - phd migration 201
