The Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD

　　Dr Markman raises a number of important issues with respect to our recent article describing the risk of ovarian cancer recurrence in the presence of a rising serum cancer antigen 125 level within the normal range.1 Unlike the primary management of ovarian cancer, management of recurrent disease is a highly individualized process, both from the perspective of the individual patient as well as the individual clinician. Our clinical practice employs a proactive approach toward early detection of recurrence and consideration to secondary cytoreductive surgery for patients with appropriate selection criteria. Among the criteria we use to identify appropriate candidates for secondary tumor cytoreduction are the patient performance status, the disease-free interval, and the focality and extent of recurrent disease. Several retrospective studies have now shown that patients most likely to benefit from secondary cytoreductive surgery will have localized small volume disease.2-5 In addition, the utility of combined positron emission tomography/computed tomography for detecting recurrent ovarian cancer when conventional imaging studies are negative or equivocal is now readily apparent.6 We certainly acknowledge that many clinicians treating women with ovarian cancer do not subscribe to this approach, and we appreciate Dr Markman's willingness to offer an alternative treatment paradigm.

　　REFERENCES

　　Santillan A, Garg R, Zahurak ML, et al: Risk of epithelial ovarian recurrence in patients with rising serum CA-125 levels within the normal range. J Clin Oncol 23:9338-9343, 2005　

　　Eisenkop SM, Friedman RL, Spirtos NM: The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 88:144-153, 2000　

　　Zang RY, Zhang ZY, Li ZT, et al: Impact of secondary cytoreduction surgery on survival of patients with advanced epithelial ovarian cancer. Eur J Surg Oncol 26:798-804, 2000　

　　Tay E, Grant PT, Gebski V, et al: Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol 99:1008-1013, 2002　

　　Onda T, Yoshikawa H, Yasugi T, et al: Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: Proposal for patients selection. Br J Cancer 92:1026-1032, 2005　

　　Bristow RE, del Carmen MG, Pannu HK, et al: Clinically occult recurrent ovarian cancer: Patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol 90:519-528, 2003　

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《临床肿瘤学医学期刊》2006年7月第24卷第20期