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Early ovarian cancer, stages I and II, is a rare presentation of epithelial ovarian cancer for which adjuvant therapy may have some efficacy. More than two decades of studies are reviewed and conclusions offered. Additionally, important issues for the future therapy of this disease are presented.

While the surgical and chemotherapeutic therapy is an established procedure for the treatment of ovarian cancer, the role of radiotherapy is not quite clear. We investigated whether the recurrence rate concerning the vaginal cuff and pelvis in ovarian cancer patients can be reduced by postoperative irradiation with afterloading technique. In retrospective analysis 20 patients with ovarian cancer, stage I-IV, received radiological contact therapy with 192-Iridium 2 x 7.5 Gy in 0.5 cm tissue depth after surgical and chemotherapeutic treatment. A control group of 20 patients with similar oncological parameters was formed. In both groups a local recurrence occurred in 6 women, which was confirmed clinically, histologically and by diagnostic devices. After 2 years, 6 of the irradiated patients survived and 11 of the control group. The results show, that the irradiation of the vaginal cuff, as applied in endometrial carcinoma, will not reduce local recurrence rate of ovarian cancer.

47 women treated by radiotherapy for gynecologic malignancies have been examined urogynecologically. There are only some changes of subjective cystometric parameters (volume of the first desire to void, bladder capacity), but statistical significant changes of the parameters "compliance" and "bladder pressure at capacity". The parameters of urethrocystometry and uroflowmetry are not influenced by irradiation. The urethroscopy demonstrates a white mucosa of the bladder wall caused by irradiation fibrosis, agreeing to data reported by literature. Only 10 of the 47 patients examined had to be treated by drugs.

Five female patients with pseudomyxoma peritonaei in various stages of disease received one or more applications of 198Au intraperitoneally. In all cases the origin of the disease was the ovary. In these patients radioactive gold was given four weeks after the diagnosis was made at laparotomy. Results with this group of patients in gratifying since no recurrence has occured in two patients who were treated one year ago and in a third patient treated five years ago. -- In two other cases 198Au was administered after a recurrence after one year, the other patient had no response at all.

Based on a material of 90 patients with malignant ovarian tumours the results of a chirurgical-radiological combination therapy are discussed. The radiotherapy with telecobalt in the area of small pelvis and regional lymphatic drainage represented achieves good results with justifiable secondary effects. The 5-year survival rate is 36,1%.

Poor survival rates of ovarian carcinoma have continued to be a cause of grave concern over decades and led to growing attention and alert in recent years. Promising results have already been recorded. More knowledge of important factors with relevance to prognosis has been helpful in unitising large-scale therapeutic studies for better comparability, a desire which had been unfulfilled in the past. Close interdisciplinary cooperation between gynaecologists, radiotherapists, and chemotherapists proved to be essential to optimum programmes of therapy. Persistent basic research for better understanding of biological behaviours of ovarian carcinomas and of so far unknown factors of prognosis and persistent efforts for earlier diagnosis of ovarian carcinoma are just as important. This is the only way to more effective control of the disease which still is, diagnostically and therapeutically, one of the major problems in gynaecology.

30 patients with ovarian dysgerminoma are reported. Whenever possible the patients were operated radically. In cases when dissemination occurred, exploration was performed. 28 patients were irradiated. Applying adequate therapy, complete growths have proved to have poor prognosis.

A report is given on 105 patients with borderline tumours of the ovary who were treated from 1953 till 1984. 78 patients suffered from epithelial, 27 from sex cord stromal or germ cell tumours. The average age of all patients was 47.7 years. 67 patients (63.8%) underwent radical operation, whereas 38 patients (36.2%) only underwent unilateral adnexectomy. Additional treatment was applied in 10 cases. Out of 78 woman with epithelial tumours 69 (88.4%) survived 5 years, 58 (74.4%) 10 years, at which the 10-years survival time is significantly higher after radical operation, which is shown by a percentage of 81.3%, compared with 51.9% after conservative operation. Over 90% of the 27 woman suffering from nonepithelial tumours survived 5 years, 87.5% 10 years, out of whom 91% had undergone conservative and 76% radical operation. Due to the existing risk radical operation is recommended in case of borderline tumours of the ovary, especially of those with epithelial origin. However, in case of young woman wanting to have children a conservative operative approach appears to be justified with observance of strict safety precautions.

47 patients with primary ovarian cancer stage I c have been treated following radical operation additionally with an intraperitoneal instillation of 5.5 GBq radioactive gold colloid. 5-year survival rate was 87 per cent. Severe complications have not been observed.

103 cases of carcinoma of the ovary stage IA are presented, which have been operated upon at our clinic from 1944 to 1970. The 5 year cure rate of the 94 cases which had been treated until 1967 was 67%. 10 of the eleven patients who had been operated upon by preserving the opposite ovary -- in 4 cases additional radiotherapy was given -- were free of carcinoma after 5 years. When radical operation was performed (bilateral salpingo-oophorectomy with or without removal of the uterus) the 5 year cure rate was 55%, with additional postoperative radiation 70%. This difference is not statistically significant. -- The therapy of choice of cancer of the ovary stage IA should be bilateral salpingo-oophorectomy and total hysterectomy with additional radiotherapy. -- Instead it may be justified in some cases to preserve the opposite ovary.