Kindly advise which course of chemotherapy to follow for the patient with following history: myomectomy-----2007 small rt. ovarian cyst was draind histopathalogical report-------no malignancy 6-7 months after surgery pt. felt rapidly growing mass in lower abdomen CT SCAN---CYST--10*9cm in diameter with 2-3cm irregular solid nodule inside mild hydronephrosis mild fatty liver CA125 62u/ml operated---cystectomy with Rt ovarotomy,cyst got ruptured during surgery Histopathological report--moderately differnciated adenocarcinoma of Rt ovary(grade II) Repeat histopathology report of same slide-----moderately differentiated adenocarcinoma of Rt ovary (gradeII)--at other institution CA125----decrease to 32 u/ml after surgery PET-CT---NO ABNORMALITY,nO PICK UP Scan---no abnormality Pt was reopened---oct.2009--Rt saphinggo-oopharotomy B/L PLND,supracolic omentectomy,RPLL,excision of node in sigmiod ,Bx from B/L dome of diaphram,peritonial washings were taken Histopathological report---moderately differentiated adenocarcinoma (grade 11)of rt ovary ramnent with sorroundig soft tissue involement omentum/nodes/nodules--- all free Chemotherapy----Received 3 courses of at 3 wkly interval with Paelitaxel 300 mg and carboplastin 400mg, last cycle on 19/12/2009 After 3 cycles--- Scan abdomen---lymphocele in rt side of abdomen.No other abnormality Scan lungs --Normal CA 125 ----88U/ml on 6/1/2010 CA 125----- 214U/ML------ 21 01 2010 USG Abd----solid nodule-2*3cm in lower rectus abdominus muscle No other abnormality FNAC---presence of malignant cells MRI Head and Neck-- insignificant 2010-22 jan.-----operated again panhysrtrectomy done and two nodules removed from anterior rectus muscle ,one on each side near incisiom. one node between uterus and rectum removed histopathological report----. Uterus---serosal deposits of 1.4 x1x0.4 cm deposits extends into myometrium Rt. rectus sheath node-- tumor deposits with tubuloglandular architechture.High grade nuclear cytology with focal mucinous differenciation.Tumour close to cut margin.cut margin is free Left rectus sheath nodule--- tumour deposits.Tumour abuts the cut margin Nodule on rectum----shows muscularis propria only CA 125 - 22.9 U/ mL Date 13.02.2010 (After Surgery) Please advise if we must follow the same chemotherapy or change the line? Thanks and regards,