Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm

Dennis, S.; Eisenhauer, Eric L.; Zivanovic, Oliver; Sonoda, Yukio; Abu‐Rustum, Nadeem R.; Levine, Douglas A.; Guile, Matthew W.; Bristow, Robert E.; Aghajanian, Carol; Barakat, Richard R.

doi:10.1016/j.ygyno.2009.03.018

Cited by 516 publications

(343 citation statements)

References 28 publications

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“…The subsequent extensive upper abdominal approach improved radicality up to 55%, translated to a further 10% improvement in OS [41].This is in correlation with the conclusion of the meta-analysis of Bristow et al [10] that every 10% incremental increase of cytoreduction to residual nodules ,2 cm enhanced the median OS of a patient cohort by 5.5%. Increasing radicality of cytoreduction from 25% to 75% would be associated with a 50% increase in median survival (from 22.7 months to 33.9 months).…”

Section: Optimal Debulking Surgery Milestonessupporting

confidence: 77%

“…Moving from standard intraperitoneal surgery toward retroperitoneal en bloc radical resection in the mid-1990s led to a 40% increaseinsurgicalradicalityandanimprovedmedianOSofatleast 10% [41]. The subsequent extensive upper abdominal approach improved radicality up to 55%, translated to a further 10% improvement in OS [41].This is in correlation with the conclusion of the meta-analysis of Bristow et al [10] that every 10% incremental increase of cytoreduction to residual nodules ,2 cm enhanced the median OS of a patient cohort by 5.5%.…”

Section: Optimal Debulking Surgery Milestonessupporting

confidence: 63%

“…Surgery performed by a gynecologic oncologist is associated with better staging, optimal cytoreduction, lower morbidity, and better survival. Both large-volume hospitals and subspecialization are independent prognostic factors for survival [42][43][44][45][46][47].Through training and implementation of a more extensive surgical approach, PDS is possible in up to 85% ofcases [10,38,41,44,45]. Despite allevidence,upto60%-80%of AOC patients still undergo suboptimal debulking surgery [8,9,23].…”

Section: Optimal Debulking Surgery Milestonesmentioning

confidence: 99%

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Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

et al. 2016

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Background. Standard treatment of stage III and IV advanced ovarian cancer (AOC) consists of primary debulking surgery (PDS) followed by chemotherapy. Since the publication of the European OrganisationforResearchandTreatmentofCancer/NationalCancer Institute of Canada trial, clinical practice has changed and many AOC patients are now treated with neoadjuvant chemotherapy (NACT) followedbyintervaldebulkingsurgery(IDS).Thebestoptionremains unclear. Ovarian cancer is a heterogenic disease. Should we use the diversityinbiologyofthetumorandpatternsoftumorlocalizationto better stratify patients between both approaches? Methods. This analysis was based on results of five phase III randomized controlled trials on PDS and IDS in AOC patients, three Cochrane reviews, and four meta-analyses.

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Section: Optimal Debulking Surgery Milestonessupporting

confidence: 77%

Section: Optimal Debulking Surgery Milestonessupporting

confidence: 63%

Section: Optimal Debulking Surgery Milestonesmentioning

confidence: 99%

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Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

et al. 2016

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“…[11,12] Though spread to these regions is considered indicative of aggressive tumor biology, complete cytoreduction in this area has shown to have a survival benefit as well. [7,13,14].…”

Section: Rational For Complete Cytoreductive Surgery (Crs) For Stage mentioning

confidence: 99%

“…[13,14,25,26,[51][52][53][54][55][56][57]. Thus, most of the results obtained with the addition of HIPEC to standard frontline therapy seem to be similar or inferior to the results obtained without the use of HIPEC.…”

Section: Hipec As First Line Therapy For Ovarian Cancermentioning

confidence: 99%

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

Bhatt

Gléhen

2016

Indian J Surg Oncol

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Ovarian cancer is one of the leading causes of cancer related deaths in women worldwide. It is usually diagnosed in an advanced stage (Stages III and IV) when peritoneal cancer spread has already occurred. The standard treatment comprises of surgery to remove all macroscopic disease followed by systemic chemotherapy. Despite all efforts, it recurs in over 75 % of the cases, most of these recurrences being confined to the peritoneal cavity. Recurrent ovarian cancer has a poor long term outcome and is generally treated with multiple lines of systemic chemotherapy and targeted therapy. The propensity of ovarian cancer to remain confined to the peritoneal cavity warrants an aggressive locoregional approach. The combined treatment comprising of cytoreductive surgery (CRS) that removes all macroscopic disease and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) has been effective in providing long term survival in selected patients with peritoneal metastases of gastrointestinal origin. Intraperitoneal chemotherapy used as adjuvant therapy has shown a survival benefit in ovarian cancer. This has prompted the use of CRS and HIPEC in the management of ovarian cancer as a part of first line therapy and second line therapy for recurrent disease. This article reviews the current literature and evidence for the use of HIPEC in ovarian cancer.

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Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer

et al. 2017

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Importance Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC). Purpose Compare overall survival of PCS versus NACT in a large national population of women with advanced-stage EOC. Design Retrospective cohort study. Setting Hospitals across the United States reporting to the National Cancer Data Base who cared for patients with advanced-stage EOC diagnosed between 2003–2011. Participants We identified women with stage IIIC and IV EOC diagnosed between 2003–2011. We focused on patients aged ≤70 years with a Charlson comorbidity index=0 who were likely candidates for either treatment. Exposure Initial treatment approach of PCS vs. NACT, examined using an intent-to-treat analysis. Main Outcome Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status [Eastern Cooperative Oncology Group (ECOG) 1–2], pre-operative disease burden, and BRCA status. Results Among 22,962 patients, 19,836 (86.4%) received PCS and 3,126 (13.6%) underwent NACT. We matched 2,935 patients treated with NACT with similar patients who received PCS. Among propensity-score matched groups, the median overall survival was 37.3 (95% CI, 35.2–38.7) months in the PCS group and 32.1 (95% CI, 30.8–34.1) months in the NACT group (P<0.001). However, if the NACT group had a higher proportion of women with performance statuses of 1–2 compared with PCS (60% vs. 50%), the association of PCS and improved survival would not be statistically significant. Conclusions and Relevance PCS was associated with improved survival compared with NACT in healthy women aged ≤70 years. The lower survival in women who received NACT could be explained by a higher prevalence of limited performance status in women undergoing NACT.

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Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm

Cited by 516 publications

References 28 publications

Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

Advanced Ovarian Cancer: Primary or Interval Debulking? Five Categories of Patients in View of the Results of Randomized Trials and Tumor Biology: Primary Debulking Surgery and Interval Debulking Surgery for Advanced Ovarian Cancer

The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review

Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer

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