Follow-up

With modern surgery and chemotherapy, the majority of patients with advanced ovarian cancer will enter a clinical remission, defined as normalization of the serum CA125 level and resolution of disease on axial imaging (CT or MRI).

However, it is known that these indicators have limited sensitivity, and that when a ‘second-look’ laparotomy was performed after treatment, a significant number of women in remission had residual disease. These operations have now been abandoned, as the outcome of women is not improved by the procedure. Follow-up strategies vary but include regular monitoring of the serum CA125 level and clinical review. There is no evidence that regular imaging by ultrasound or CT scanning, or PET imaging improves survival. While clear definitions of relapse measured by CA125 levels have been developed (54), there is no evidence from a CA125 follow-up trial that early institution of second-line chemotherapy based on a raised CA125 level leads to an improvement in overall survival (55). In the trial, CA125 levels identified relapse about 4.8 months before clinical relapse. The interpretation of these results has varied, ranging from those who feel that routine CA125 measurement is not worthwhile to those who feel it drives imaging which may identify patients suitable for secondary debulking surgery (see ‘Surgical debulking options at relapse’). In routine clinical practice, the CA125 level is commonly checked approximately every 3 months in the first 2 years, and CT scanning is triggered by the CA125 level or symptoms. Follow-up intervals are usually extended beyond 2 years as the majority of relapses will have occurred by this time.

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Source: Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p.. 2020

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Follow-up

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