**7. Adjuvant chemotherapy in early stage disease**

After surgery, there is still a risk that cancer cells remain and may return or spread to other organs of the body. Adjuvant chemotherapy is administered after surgery to destroy these cells and improve the chance of curing ovarian cancer and to decrease the risk of the death due to ovarian cancer.

A recent Cochrane meta-analyses of five prospective clinical trials (4 of 10 with platinumbased chemotherapy) demonstrated that chemotherapy is more beneficial than observation in patients with adequately staged early-stage ovarian cancer [26]. Patients who received adjuvant chemotherapy had better OS [hazard ratio (HR) 0.71; 95% confidence interval (CI) 0.53–0.93] and PFS (HR 0.67; 95% CI 0.53–0.84) than patients who did not receive adjuvant treatment [26].

Two-thirds of the patients included in the two major studies were suboptimally staged, in optimally staged patients, benefit for chemotherapy cannot be excluded, Long-term follow-up of the ICON 1 trial confirms the benefit of adjuvant chemotherapy, particularly in those patients at higher risk of recurrence (stage 1B/C grade 2/3, any grade 3 or clear-cell histology) [26].

Therefore, adjuvant chemotherapy should be recommended not only to suboptimally staged patients but also to those optimally staged at higher risk of recurrence [16].
