Stellenwert der Rezidivchirurgie in der Behandlung des Ovarialkarzinoms

Abstract

Recurrent ovarian cancer is still a significant problem despite intensive primary therapy, consisting of radical surgery and subsequent chemotherapy. The primary reason for consequent follow up investigations and immediate start of second-line therapy in cases of recurrence is based on the fact, that patients with relapse more than 12 months after primary therapy have a mean survival of 105 weeks after diagnosis. The value of surgical treatment is controversially discussed in the literature. Several authors argue, that there is no definitive prolongation of survival. Between January 1984 and July 1990, 285 patients presented themselves at our hospital with recurrence or progression of ovarian cancer. 72 of these patients had surgical treatment and those patients are part of the investigation. The mean survival of the patients (n = 18), which were operated with no remaining tumour, was 166 weeks. The average survival time of the 22 women with up to 2 cm remaining tumour was 108 weeks. The average survival time of the 32 patients with more than 2 cm after surgery was 72 weeks. One important criterion for the achievable tumour-free situation after surgery was the distinction between primary progression and relapse, where relapse was defined as recurrence more than 12 months after primary treatment. 29% of the patients with relapse could be operated tumour-free, a situation which could be achieved only in one of 13 patients (8%) with primary progression of the disease. Surgery in recurrent ovarian cancer is only indicated in patients with relapse more than 12 months after primary surgery. Tumour-free patients have significant benefit from the surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of surgery in recurrent ovarian cancer

“…Also, collectives in publications are probably similarly selected. In the published series, rates of complete resection between 9% and 82% and a share of inoperable patients with 12-45% are given (5)(6)(7)(8)(9)(11)(12)(13)(14)(15)(16)(17)(18) . Thus, the operative results of this study (45.9% of patients with complete tumor resection) appear in the upper middle.…”

“…Some studies, for instance, showed that complete tumor resection alone correlates with longer survival (5,12,19) . Other authors reported that also at surgery for recurrence, patients could benefit from ''optimal debulking'' with residual tumors of up to 1 or 2 cm (6,7) . In the present study in which so far the largest series of surgeries for recurrence has been analyzed, the results of Eisenkop (5,19) were confirmed, and we found that only patients in whom complete tumor resection can be achieved benefit from surgery for recurrence.…”

“…However, it has been shown on various instances that patients benefit from a complete or optimal tumor resection (3,4) . In contrast to this, operative therapy in recurrent ovarian cancer (ROC) plays a minor role, although there are indications for advantages in survival also, in this setting, in case of complete or optimal tumor resection (5)(6)(7)(8)(9) . Nevertheless, the role of surgery in recurrence still leaves a few questions unanswered.…”

Sinnvoller Einsatz der Tumormarker beim Ovarialkarzinom

“…Der bereits erwähnte unreflektierte Einsatz von Tumormarkern in der Nachsorge, vor allem die Mehrfachbestimmung und die zu häufige Bestimmung, hat zu einer Diskussion darüber geführt, ob die regelmäßige Bestimmung von CA 125 im weiteren Verlauf nach Primärtherapie überhaupt gerechtfertigt ist [50,51]. Bevor diese Frage diskutiert wird, muß jedoch bedacht werden, daß die Rezidivdiagnostik mittels Tumormarker beim Ovarialkarzinom momentan deutlich besser ist als die zur Verfügung stehende Second-line-Therapie.…”

“…Bevor diese Frage diskutiert wird, muß jedoch bedacht werden, daß die Rezidivdiagnostik mittels Tumormarker beim Ovarialkarzinom momentan deutlich besser ist als die zur Verfügung stehende Second-line-Therapie. Während Patientinnen mit Frühre-zidiv im Mittel lediglich 26 Wochen ab Rezidiv überleben, liegt dieser Zeitraum bei Patientinnen mit Spätrezidiv bei 105 Wochen [51]. Während Patientinnen mit Frühre-zidiv im Mittel lediglich 26 Wochen ab Rezidiv überleben, liegt dieser Zeitraum bei Patientinnen mit Spätrezidiv bei 105 Wochen [51].…”