Moving beyond “complete surgical resection” and “optimal”: Is low-volume residual disease another option for primary debulking surgery?

Manning‐Geist, Beryl; Hicks-Courant, Katherine; Gockley, Allison; Clark, Rachel M.; Carmen, Marcela G. del; Growdon, Whitfield B.; Horowitz, Neil S.; Berkowitz, Ross S.; Muto, Michael G.; Worley, Michael J.

doi:10.1016/j.ygyno.2018.06.015

Cited by 22 publications

(21 citation statements)

References 14 publications

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Section: The Benefits Of Maximal Cytoreductive Surgery and The Considsupporting

confidence: 80%

“…In agreement with well-known concepts [142][143][144][145][146], a rapid reduction in the tumor burden is the guarantee of successful treatment in cancer patients. Nearly all studies have confirmed that maximal cytoreduction surgery is the most critical step in the management of patients with advanced-stage ETOC or PPSC [142][143][144][145][146]. According to the definition of the Gynecologic Oncology group (GOG) for 'optimal' as having residual tumor nodules which should be ≤ 1 cm in size, the Cochrane review revealed that the outcome of ETOC patients with residual disease ≤ 1 cm is better than of those with residual disease > 1 cm [143], although it is well known that PCS to no gross residual tumor might be associated with the longest PFS and OS [144,145].…”

Section: The Benefits Of Maximal Cytoreductive Surgery and The Considsupporting

confidence: 80%

“…Nearly all studies have confirmed that maximal cytoreduction surgery is the most critical step in the management of patients with advanced-stage ETOC or PPSC [142][143][144][145][146]. According to the definition of the Gynecologic Oncology group (GOG) for 'optimal' as having residual tumor nodules which should be ≤ 1 cm in size, the Cochrane review revealed that the outcome of ETOC patients with residual disease ≤ 1 cm is better than of those with residual disease > 1 cm [143], although it is well known that PCS to no gross residual tumor might be associated with the longest PFS and OS [144,145]. One study showed an interesting finding that patients still had diverse outcomes despite undergoing optimal PCS (≤ 1 cm residual disease), in which it demonstrated that patients with a tumor limited in a single anatomic location had better median PFS and OS than patients with tumors widely distributed in multiple anatomic locations [146].…”

Section: The Benefits Of Maximal Cytoreductive Surgery and The Considmentioning

confidence: 99%

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Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Huang

Chen

Lee

et al. 2020

IJERPH

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The use of weekly chemotherapy for the treatment of patients with advanced-stage serous-type epithelial Tubo-ovarian cancer (ETOC), and primary peritoneal serous carcinoma (PPSC) is acceptable as the front-line postoperative chemotherapy after primary cytoreductive surgery (PCS). The main component of dose-dense chemotherapy is weekly paclitaxel (80 mg/m2), but it would be interesting to know what is the difference between combination of triweekly cisplatin (20 mg/m2) or triweekly carboplatin (carboplatin area under the curve 5-7 mg/mL per min [AUC 5-7]) in the dose-dense paclitaxel regimen. Therefore, we compared the outcomes of women with Gynecology and Obstetrics (FIGO) stage IIIC ETOC and PPSC treated with PCS and a subsequent combination of dose-dense weekly paclitaxel and triweekly cisplatin (paclitaxel–cisplatin) or triweekly carboplatin using AUC 5 (paclitaxel–carboplatin). Between January 2010 and December 2016, 40 women with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC EOC, FTC, or PPSC were enrolled, including 18 treated with paclitaxel–cisplatin and the remaining 22 treated with paclitaxel–carboplatin. There were no statistically significant differences in disease characteristics of patients between two groups. Outcomes in paclitaxel–cisplatin group seemed to be little better than those in paclitaxel–carboplatin (median progression-free survival [PFS] 30 versus 25 months as well as median overall survival [OS] 58.5 versus 55.0 months); however, neither reached a statistically significant difference. In terms of adverse events (AEs), patients in paclitaxel–carboplatin group had more AEs, with a higher risk of neutropenia and grade 3/4 neutropenia, and the need for a longer period to complete the front-line chemotherapy, and the latter was associated with worse outcome for patients. We found that a period between the first-time chemotherapy to the last dose (6 cycles) of chemotherapy >21 weeks was associated with a worse prognosis in patients compared to that ≤21 weeks, with hazard ratio (HR) of 81.24 for PFS and 9.57 for OS. As predicted, suboptimal debulking surgery (>1 cm) also contributed to a worse outcome than optimal debulking surgery (≤1 cm) with HR of 14.38 for PFS and 11.83 for OS. Based on the aforementioned findings, both regimens were feasible and effective, but maximal efforts should be made to achieve optimal debulking surgery and following the on-schedule administration of dose-dense weekly paclitaxel plus triweekly platinum compounds. Randomized trials validating the findings are warranted.

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Section: The Benefits Of Maximal Cytoreductive Surgery and The Considsupporting

confidence: 80%

Section: The Benefits Of Maximal Cytoreductive Surgery and The Considsupporting

confidence: 80%

Section: The Benefits Of Maximal Cytoreductive Surgery and The Considmentioning

confidence: 99%

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Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Huang

Chen

Lee

et al. 2020

IJERPH

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“…If R0 was not attained, low volume disease confined to single anatomic locations (≤1 cm-SL) may be an alternative [38]. The study showed that patients with RD ≤ 1 cm involving multiple anatomic locations (≤1 cm-ML) had similar outcomes to suboptimal debulked (RD>1 cm) patients [38]. Moving beyond complete cytoreduction, low volume RD may be another option for consideration.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

Gao

Zhang

et al. 2019

J Ovarian Res

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Objective To compare the chemoresistance and survival in patients with stage IIIC or IV epithelial ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS). The clinical characteristics of patients who benefited from NACT were further evaluated. Methods We retrospectively analyzed 220 patients who underwent NACT followed by IDS or PDS from January 2002 to December 2016. Differences in clinicopathological features, chemoresistance and prognosis were analyzed. Results The incidence rate for optimal cytoreduction and chemoresistance in the NACT group was relatively higher than PDS group. No differences were observed in progression free survival or overall survival. Patients without macroscopic RD in NACT group (NACT-R0) had a similar prognosis compared to those in PDS group who had RD<1 cm, and a relatively better prognosis compared to the PDS group that had RD ≥ 1 cm. The survival curve showed that patients in NACT-R0 group that were chemosensitive seemed to have a better prognosis compared to patients in PDS group that had RD. Conclusion Patients without RD after PDS had the best prognosis, whereas patients with RD after NACT followed by IDS had the worst. However, even if patients achieved no RD, their prognosis varied depending on chemosensitivity. Survival was better in patients who were chemosensitive compared to thosewho underwent PDS but had RD. Hence evaluating the chemosensitivity and feasibility of complete cytoreduction in advance is crucial.

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“…In the 2018 SGO (Society of Gynecologic Oncology) annual meeting on women's cancer, Dr. Beryl suggested a new prospective. If R0 was not attained, low volume disease confined to single anatomic locations (≤1 cm-SL) may be an alternative [27]. The study showed that patients with RD ≤ 1 cm involving multiple anatomic locations (≤1 cm-ML) had similar outcomes to suboptimal debulked (RD > 1 cm) patients.…”

Section: Discussionmentioning

confidence: 92%

Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

Amin¹,

Ahmed²,

Refaat³

et al. 2020

JCT

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Background: Ovarian cancer (OC) is the most lethal gynecologic malignancy. About 70% of ovarian cancer patients have advanced disease and often not totally resectable. Previous studies of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) versus primary debulking surgery (PDS) give inconsistent results. The aim of this retrospective study is to evaluate the outcome of the neoadjuvant chemotherapy followed by IDS versus PDS followed by adjuvant chemotherapy for the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer. Methods: This study was performed on eligible patients with ovarian cancer admitted in Surgical Oncology and Medical Oncology departments at South Egypt Cancer Institute-Assiut University in the period from January 2010 to December 2015. Patients were divided into two groups, the first group included those who have NACT and underwent IDS plus adjuvant chemotherapy, and the second group included those who underwent PDS followed by adjuvant chemotherapy. Results: This study included 380 cases. One hundred and fifty-four patients (40.53%) had IDS. The remaining two hundred and twenty-six patients (59.47%) underwent PDS. In this study, treatment modality was significant for both disease-free survival (DFS) and overall survival (OS). DFS was significantly reduced after IDS when compared to PDS (median DFS: 33.00 months vs. 45.00 months, respectively; p < 0.001). Also, OS was significantly reduced after IDS when compared to PDS.

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Moving beyond “complete surgical resection” and “optimal”: Is low-volume residual disease another option for primary debulking surgery?

Cited by 22 publications

References 14 publications

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Comparing Paclitaxel–Carboplatin with Paclitaxel–Cisplatin as the Front-Line Chemotherapy for Patients with FIGO IIIC Serous-Type Tubo-Ovarian Cancer

Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

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