Introduction

In 2008, 225000 women worldwide were diagnosed with ovarian cancer and an estimated 140000 died of the disease. This makes ovarian cancer the most lethal gynaecological malignancy. In spite of the increased overall 5 year survival, the mortality rate from the disease has shown either a slight decrease or even an increase in certain age groups. For example, in the UK, the 5 year survival increased from 21% in 1971—75 to 38.9% in 2001—06 but the mean mortality rate only decreased by 10% over the same period (from 12.02 per 100000 to 10.77 per 100000, respectively), with a paradoxical increase in mean mortality rate in the over-65 age group over the same period of 37% (from 40.8 per 100000 to 55.8 per 100000, respectively). A similar trend has been observed in the USA, where the 5 year survival increased from 37% in 1975—77 to 45% in 1999—2006 (P < 0.05). However, the mean mortality rate only decreased by 11.4% over the same time period (from 9.8 per 100000 to 8.8 per 100000, respectively). Similarly, the mean mortality rate in the over-65 age group increased by 15.7% (from 38.4 per 100000 to 44.5 per 100000, respectively). Improved progression-free survival (PFS) and overall survival (OS) in developed countries possibly relates to the more consistent use of cytoreductive surgery and to the development of combination chemotherapy for primary and recurrent disease.