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

Abstract

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.

Narrative review of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with advanced ovarian cancer: a critical reappraisal of the current evidence

“…For the 140 patients with residual disease, 80 had CRS + HIPEC + systemic chemotherapy and the other 60 had CRS and systemic chemotherapy without HIPEC. Table 1 presents the survival outcomes of the study by Spiliotis et al (10 patients with splanchnic metastases not included) (13). The data suggests a significance of a complete cytoreduction (patients with residual disease) in the primary management of advanced ovarian cancer, which was further enhanced by the addition of HIPEC with improved survival in patients with residual disease compared to recurrent ones (38 vs. 26 months, respectively).…”

“…The patients in this protocol are still followed by our study group based on the platinum resistance, including cisplatin plus paclitaxel in platinum sensitive disease and doxorubicin plus paclitaxel or mitomycin in platinum resistant disease. In another study by Spiliotis et al, the authors searched for differences in survival of patients who received cytoreductive surgery (CRS) plus HIPEC as secondary management of residual versus recurrent disease after primary surgery (13). More specifically, 200 patients with relapse of ovarian cancer were divided into 5 groups.…”

“…Survival outcomes of 190 patients with residual or recurrent ovarian cancer patients reported by Spiliotis et al(13) …”

Retrospective Study and Current Realities and Possibilities of Surgical Treatment of Ovarian Cancer

“…Це ускладнює прогноз при даному захворюванні. У зв'язку з цим найважливішим прогностичним фактором у цих пацієнтів є залишкова пухлина після первинної операції [13][14][15][16].…”

Electrochemotherapy with Calcium Chloride and 17β-Estradiol Modulated Viability and Apoptosis Pathway in Human Ovarian Cancer

“…The first-line treatment includes primary tumor debulking surgery and six cycles of subsequent chemotherapy (CT) with cisplatin or its derivatives [ 4 ]. Around 70% of patients relapse and then do not respond to the standard treatment method [ 6 ]. The reason is, cancer cells frequently acquire secondary drug resistance as a result of repeated chemotherapy [ 7 ].…”