Secondary Surgical Cytoreduction for Advanced Ovarian Carcinoma

Rose, Peter G.; Nerenstone, Stacy; Brady, Mark F.; Clarke‐Pearson, Daniel L.; Olt, George J.; Rubin, Stephen C.; Moore, David H.; Small, James

doi:10.1056/nejmoa041125

Cited by 355 publications

(168 citation statements)

References 28 publications

(24 reference statements)

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“…After screening the abstracts, assessing the full-text articles, and identifying additional records through the reference lists of selected articles, we included 5 RCTs [5][6][7][8][9], 3 meta-analyses, and 3 Cochrane reviews [10][11][12][13][14][15][16] in this review. Three RCTs compared NACT-IDS with chemotherapy only [5][6][7]. Two RCTs compared PDS with NACT-IDS [8,9].…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

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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“…Critics of secondary cytoreductive surgery counter that the same favorable prognostic factors that define ideal candidates for secondary cytoreductive surgery also characterize those patients who will experience extended postrecurrence survival with salvage chemotherapy alone. 34,35 These prognostic factors include the amount of residual disease after the procedure and the length of the disease-free interval. 9,10,12,[14][15][16][17][18][19][20][21][22][23][24][25][26]33 A number of studies have shown that patients who are left with no or minimal residual disease at the time of secondary cytoreductive surgery have a median survival that ranges from 38 months to 61 months compared with 4.5 months to 27 months for patients who undergo suboptimal cytoreduction.…”

Section: Discussionmentioning

confidence: 99%

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

Salani

Santillan

Zahurak

et al. 2007

Cancer

132

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BACKGROUND.The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease.METHODS.Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival.RESULTS.Fifty‐five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis‐to‐recurrence interval was 32 months (range, 12–164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis‐to‐recurrence interval ≥18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA‐125 level, ascites, and tumor size were not associated significantly with survival.CONCLUSIONS.The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis‐to‐recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months. Cancer 2007. © 2007 American Cancer Society.

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“…However, the US GOG152 study and a small-scale British randomized controlled trial (RCT) (4,5) demonstrated no benefit in survival rates. Previous joint study efforts of the EORTC and National Cancer Institute of Canada identified that neoadjuvant chemotherapy is no less effective than standard first-line treatment (6,7). Nevertheless, in the present case neoadjuvant chemotherapy resulted in a favorable outcome.…”

Section: Discussionmentioning

confidence: 50%

Effective treatment of a patient with stageï¿½IV ovarian cancer: A case report

et al. 2017

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Abstract. The present case report describes a patient with stage IV ovarian cancer who survived for 9 years without achieving a complete remission since the first relapse. The patient's long-term survival may be ascribed to the slow growth of the cancer cells, limited metastasis and favorable responses to the treatments received. The patient manifested initially with malignant pleural effusion and was not able to tolerate surgical treatment. However, the disease was well-controlled using various treatments, including neoadjuvant chemotherapy, interval cytoreductive surgery and post-operative long-term chemotherapy. Management of ovarian cancer is most effective when tailored to the individual needs of the patient, maximizing its efficacy and prolonging the patient's survival rate. The present case may offer useful insight into the clinical management of stage IV ovarian cancer IntroductionAmong all types of female reproductive system cancer, ovarian cancer has the second highest incidence rate and the highest mortality rate (1). At the time of diagnosis, 75% of patients are at an advanced stage (III or IV) (2). The 5-year survival rate decreases rapidly between stages I and IV (3). Currently, no effective methods exist for the screening and early diagnosis of ovarian cancer. The majority of patients have already reached advanced stages at diagnosis, resulting in a poor prognosis (2). The 5-year relative survival rate ranges from between 30 and 40% at stage III to <10% at stage IV (2).Nevertheless, practicing personalized medicine catering to individual responses and a timely follow-up may achieve a satisfactory therapeutic outcome in certain advanced-stage patients. In the present case report, the step-by-step management protocol followed for a patient with stage IV ovarian cancer who survived for >9 years is described. As it is rare for a patient with advanced-stage ovarian cancer to demonstrate such favorable prognosis, it is hoped that the treatment protocol may be of assistance to clinicians encountering a similar case. The patient provided written informed consent for the publication of the present study. Case reportThe patient was a 48-year-old female who was admitted to the pulmonary department of Qilu Hospital of Shandong University (Jinan, China) due to a severe irritating cough and chest tightness in July 2004. The patient's mother had a history of tuberculosis. Computed tomography (CT) scan results revealed pleural effusion in the right lung and pericardial effusion with mild ascites. The suspected diagnosis upon admission was tuberculous pleurisy. Thoracocentesis yielded 1,000 ml yellow serous exudate, which tested negative for Mycobacterium tuberculosis and malignant cells. Abdominal paracentesis also revealed similar results. Physical examination revealed a palpable mass in the recto-uterine pouch. After 2 weeks of conservative therapy, the patient's situation was slightly improved. However, at the end of the third week, the patient's condition began to deteriorate. Lumps appeared on the right arm ...

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Secondary Surgical Cytoreduction for Advanced Ovarian Carcinoma

Abstract: For patients with advanced ovarian carcinoma in whom primary cytoreductive surgery was considered to be maximal, the addition of secondary cytoreductive surgery to postoperative chemotherapy with paclitaxel plus cisplatin does not improve progression-free survival or overall survival.

Cited by 355 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

Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

Effective treatment of a patient with stageï¿½IV ovarian cancer: A case report

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