The patients who relapse are regrettably many for only 25% of the total ovarian population present with the highly curable stage 1 disease. Often the relapse is one to two years or so in the coming, as the adjunctive chemotherapy certainly delays recurrence in those for whom it does not effect complete cure. ‘ Second line’ chemotherapy agents are many and reintroduction of the original chemotherapy regimen (say platin plus taxol) may be tried first if it has served an individual well (i.e. it has effected a long remission of longer than 6-9 months). If the remission with standard first line chemotherapy has been short lived, then alternative drugs such as adriamycin, cyclophosphamide and topotecan, are worhty of trial as all are active. However, the chance of second line therapy curing the patient is very small indeed, despite clever use of the drugs or combining it with radiotherapy or surgery to obvious masses of abdominal disease.
