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Abstract
Adjuvant chemotherapy with an alkylating agent, melphalan, did not prolong survival significantly. [...]patients fortunate enough to have their cancer diagnosed and removed while it appeared to remain intact and in whom surgeons have made the effort to perform comprehensive staging can be spared the need for adjuvant chemotherapy, with its attendant morbidity and mortality. [...]the ability of this particular adjuvant treatment to influence survival is theoretically limited. Because melphalan conferred no greater benefit than 32 P, it is entirely possible that the survival rate is a result of the more careful selection (through operative staging) of patients who have lower rates of relapse than most patients with occult (microscopic) Stage III disease. Furthermore, on the basis of the outcomes in the patients with Stage I or II borderline ovarian tumors who were excluded from the analysis of the randomized study, the authors have concluded that adjuvant treatment is not warranted in such patients. Because chemotherapy for advanced ovarian cancer with combinations of drugs that contain cisplatin appears to yield a substantial proportion of long-term survivors,12 one could speculate that similar regimens might have a pronounced effect on the rate of relapse in patients with Stage I or II disease.