Positive DESKTOP and Tian Scores Systems Are Adequate to Predict Optimal (R0) Secondary Debulking Surgery in Ovarian Cancer, But a Negative Score Does Not Preclude Secondary Surgery

Laga, Tina; Lambrechts, Sandrina; Laenen, Annouschka; Nieuwenhuysen, Els Van; Han, Sileny N.; Vergote, Ignace

doi:10.1097/igc.0000000000001219

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…More specifically, the median survival was 57.7 months in women achieving R0 during secondary cytoreduction compared with 27.0 months in the R1 group, and 15.6 months in the R2 group (8,9). Furthermore, Laga et al (10) confirmed that DESKTOP score and the Tian model were the main predictors of candidate selection for complete secondary cytoreduction. However, in their study, 61% and 70% of the patients were debulked to R0 independently of the negative preoperative scores.…”

Section: Discussionmentioning

confidence: 97%

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Secondary debulking for ovarian carcinoma relapse: The R-R dilemma – is the prognosis different for residual or recurrent disease?

Spiliotis¹,

Iavazzo²,

Kopanakis³

et al. 2019

J Turkish German Gynecol Assoc

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Objective: To analyze the kind of ovarian cancer relapse by separating residual from recurrent disease and correlating them with patient survival. Material and Methods:This was a retrospective study of 200 women with ovarian carcinoma relapse between 2005 and 2017. Results:The main sites of residual disease included the great omentum, epiploic appendices, liver round ligament, gallbladder, and cervical/ vaginal stump. The median survival for women with residual disease treated with cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC) + systemic chemotherapy was 38 months compared with the control group, which reached 23.8 months. The morbidity rates were 18% vs 7%, respectively, and the mortality rates were 2.5% vs 1.3%. The main sites of recurrent disease included the mesenterium, pelvic floor, diaphragm, and Glisson's capsule. Women with recurrent disease treated with CRS + HIPEC + systemic chemotherapy had median survival rates of 26 months vs 16 months in the control group. The morbidity rates were 22% vs 15%, respectively, and the mortality rates were 3.3% vs 0%. Conclusion:Patients undergoing secondary debulking plus HIPEC for ovarian carcinoma relapse have a different prognosis when compared with patients with residual and recurrent disease. A different prognosis is presented in women undergoing secondary debulking plus HIPEC for ovarian carcinoma relapse when comparing patients with residual and recurrent disease.

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Section: Discussionmentioning

confidence: 97%

“…However, in their study, 61% and 70% of the patients were debulked to R0 independently of the negative preoperative scores. For this reason, they suggested that other anatomic and metabolic imaging criteria should be evaluated to recognize eligible patients for HIPEC plus secondary cytoreduction (10).…”

Section: Discussionmentioning

confidence: 99%

Secondary debulking for ovarian carcinoma relapse: The R-R dilemma – is the prognosis different for residual or recurrent disease?

Spiliotis¹,

Iavazzo²,

Kopanakis³

et al. 2019

J Turkish German Gynecol Assoc

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“…We would still highlight that both scores identify a subset of patients who could achieve CGR, but do not select patients who are suitable candidates for surgery compared to chemotherapy. Further studies and discussion are warranted so as not to prohibit patients from having potential life-extending surgery ( 36 – 38 ). In addition, preoperative imaging is an essential tool in making the right decision ( 4 ).…”

Section: Evaluation and External Verification Of The Three Prediction Modelsmentioning

confidence: 99%

“…Several studies have suggested that additional refinement of the score, such as with whole-body MRI or PET-CT, is needed to exclude women from SCS. Overall, the selection criteria and potential beneficial subpopulation of CGR could be ultimately refined in future clinical practice ( 38 ).…”

Section: Evaluation and External Verification Of The Three Prediction Modelsmentioning

confidence: 99%

Prediction Models for Complete Resection in Secondary Cytoreductive Surgery of Patients With Recurrent Ovarian Cancer

Jiang

2021

Front. Oncol.

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The most advanced epithelial ovarian cancer develops recurrent disease despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. Treatment with secondary cytoreductive surgery (SCS) combined with chemotherapy or with chemotherapy alone for patients with platinum-sensitive recurrent ovarian cancer (ROC) is currently under heated discussion. Encouragingly, the results of the AGO DESKTOP III Study and the SOC1/SGOG-OV2 trial, which have been published recently, showed a striking advantage in terms of overall survival (OS) and progression-free survival (PFS) of ROC patients undergoing SCS compared to chemotherapy alone; moreover, a benefit of SCS exclusively for patients with complete gross resection (CGR) was particularly highlighted. CGR is considered the ultimate goal of SCS, on condition that the balance between maximal survival gain and minimal operative morbidity is maintained. Several models have been proposed to predict the rate of CGR, such as the MSK criteria, the AGO score, and the Tian model, over the last 15 years. This summary is mainly about the several previously published prediction models for CGR in SCS of ROC patients and discusses the effectiveness and limitations of these prediction models.

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“…A subset of patients who had residual lesions after the primary surgery, or with ascites at the time of recurrence, or relapsed with a high CA125 level, or combined with extra-abdominal recurrence, may also be candidates for post-recurrence cytoreduction. Consequently, further research into reasonable selection criteria is warranted so as not to prohibit patients from undergoing potential life-extending surgery [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cytoreductive surgery is feasible in patients with limited regional platinum-resistant recurrent ovarian cancer

Zou,

Jiang,

Luo

et al. 2023

World J Surg Onc

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Introduction To evaluate the efficacy of cytoreductive surgery versus chemotherapy for the treatment of limited regional, platinum-resistant ovarian cancer (PROC). Materials and methods The clinical records of all patients with PROC treated in our center between March 2015 and March 2022 were retrospectively reviewed. We compared the oncology outcomes of patients who received cytoreduction or chemotherapy alone at relapse and presented information about postoperative adjuvant chemotherapy. Results Among 52 patients with limited regional recurrence, 40.4% (21/52) underwent cytoreduction because of platinum resistance, and 59.6% (31/52) received chemotherapy alone. No residual disease (R0) was achieved in 20 patients (95.2%). The severe morbidity rate within 30 days after the surgery was 15%. The median follow-up was 70.6 months. Compared with the chemotherapy alone group, the surgery group with R0 had better progression-free survival (PFS) (10.6 vs. 5.1 months; hazard ratio (HR) = 0.421; P = 0.0035) and post-relapse survival (PRS) (32.6 vs. 16.3 months; HR = 0.478; P = 0.047), but there was no difference in overall survival (OS) between the two groups. Laparoscopy is associated with lesser intraoperative blood loss with no differences in survival and postoperative complications compared to the open approach (P = 0.0042). Subgroup survival analysis showed that compared with chemotherapy alone, surgery prolonged PFS in patients regardless of tumor size (greater than or equal to 4 cm or less). Surgery group patients who achieved R0 had an objective response rate (ORR) of 36.8% (7/19), among whom 40% (4/10) received platinum rechallenge chemotherapy and 33.3% (3/9) were administered non-platinum chemotherapy. Conclusion When well-selected PROC patients with limited regional recurrence achieved R0, their outcomes were superior to those of patients who received only chemotherapy with an acceptable morbidity rate. Laparoscope technology could be a reliable alternative surgical approach. The reintroduction of platinum agents may be considered following surgery. Further analyses in a larger population are warranted to elucidate the risks and benefits of this surgery and adjuvant chemotherapy strategy.

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Positive DESKTOP and Tian Scores Systems Are Adequate to Predict Optimal (R0) Secondary Debulking Surgery in Ovarian Cancer, But a Negative Score Does Not Preclude Secondary Surgery

Cited by 6 publications

References 32 publications

Secondary debulking for ovarian carcinoma relapse: The R-R dilemma – is the prognosis different for residual or recurrent disease?

Secondary debulking for ovarian carcinoma relapse: The R-R dilemma – is the prognosis different for residual or recurrent disease?

Prediction Models for Complete Resection in Secondary Cytoreductive Surgery of Patients With Recurrent Ovarian Cancer

Cytoreductive surgery is feasible in patients with limited regional platinum-resistant recurrent ovarian cancer

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