Are Surveillance Procedures of Clinical Benefit for Patients Treated for Ovarian Cancer?: A Retrospective Italian Multicentric Study

Abstract

The aim of this retrospective investigation was to assess the pattern of failures of 412 patients with recurrent ovarian cancer followed up with different surveillance protocols.Time to recurrence was less than 6 months in 98 women (23.8%), 6 to 12 months in 102 women (24.7%), and more than 12 months in 212 women (51.5%). Symptoms at relapse were referred by 81 women (19.7%). Among the 331 asymptomatic patients, the surveillance procedure that raised the suspect of recurrent disease was clinical examination in 49 (14.8%), imaging technique in 90 (27.2%), serum CA 125 in 77 (23.3%), and both serum CA 125 and imaging technique in 115 (34.7%). At univariate analysis, survival from initial diagnosis was related to stage (P = 0.004), residual disease after initial surgery (P < 0.0001), time to recurrence (P < 0.0001), site of relapse (P = 0.04), and treatment at recurrence (P < 0.0001), and survival after recurrence was related to stage (P = 0.01), residual disease (P < 0.0001), time to recurrence (P < 0.0001), and treatment at recurrence (P < 0.0001). Conversely, symptoms at recurrence had no prognostic relevance. Cox proportional hazards model showed that residual disease and time to recurrence were the only independent prognostic variables for both survival from initial diagnosis (P < 0.0001) and survival after recurrence (P < 0.0001). In conclusion, there was no survival difference between asymptomatic and symptomatic patients at the time of relapse, and therefore, the diagnostic anticipation allowed by a scheduled follow-up protocol did not seem to improve the clinical outcome of patients who ultimately developed recurrent disease.

Patterns of Recurrence and Role of Pelvic Radiotherapy in Ovarian Clear Cell Adenocarcinoma

“…These findings are also consistent with early-stage EOC studies where a median interval to recurrence of 11 to 29 months is described. 10,29 Historically, ovarian cancers have been conceptualized as a single entity, and tumor cell type has not been used as a prognostic marker or a predictor of treatment efficacy. New data, however, suggest that tumor cell type defines biologically distinct entities within EOC.…”

No Supportive Evidence for Clinical Benefit of Routine Follow-Up in Ovarian Cancer: A Dutch Multicenter Study

“…9Y11 Two projects were observational multicenter studies, both mentioning a high proportion of asymptomatically detected recurrences at routine follow-up visits. 10,11 However, the findings on the survival difference between routine and interval recurrences were inconsistent. Rustin et al 9 conducted a randomized trial that revealed no survival benefit of immediate treatment based on CA125 elevation over delayed treatment until signs or symptoms of recurrent disease occurred.…”

Follow-Up of Patients Who Are Clinically Disease-Free after Primary Treatment for Fallopian Tube, Primary Peritoneal, or Epithelial Ovarian Cancer: A Program in Evidence-Based Care Guideline Adaptation

“…Twelve full-text studies constituted the evidence base for t he present g u ideline : one rct of c a125 i n fol low-up 15 ; five retrospective cohort studies on methods of detection [16][17][18][19][20] ; two pilot studies 21,22 ; and four qualitative or observational studies of psychosocial concerns, health care provider and patient preferences or satisfaction, and patterns of care [23][24][25][26] . Eleven of those studies fell within the scope of our guideline; one study about sexual symptomatology was out-of-scope 22 …”