Surgical cytoreduction for recurrent epithelial ovarian cancer

Abstract

BackgroundThe standard management of primary ovarian cancer is optimal cytoreductive surgery followed by platinum-based chemotherapy. Most women with primary ovarian cancer achieve remission on this combination therapy. For women achieving clinical remission after completion of initial treatment, most (60%) with advanced epithelial ovarian cancer will ultimately develop recurrent disease. However, the standard treatment of women with recurrent ovarian cancer remains poorly defined. Surgery for recurrent ovarian cancer has been suggested to be associated with increased overall survival. ObjectivesTo evaluate the effectiveness and safety of optimal secondary cytoreductive surgery for women with recurrent epithelial ovarian cancer. To assess the impact of various residual tumour sizes, over a range between 0 cm and 2 cm, on overall survival. Search methodsWe searched the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to December 2012. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. For databases other than MEDLINE, the search strategy has been adapted accordingly. Selection criteriaRetrospective data on residual disease, or data from randomised controlled trials (RCTs) or prospective/retrospective observational studies that included a multivariate analysis of 50 or more adult women with recurrent epithelial ovarian cancer, who underwent secondary cytoreductive surgery with adjuvant chemotherapy. We only included studies that defined optimal cytoreduction as surgery leading to residual tumours with a maximum diameter of any threshold up to 2 cm. Data collection and analysisTwo review authors (KG, TA) independently abstracted data and assessed risk of bias. Where possible the data were synthesised in a meta-analysis.

“Things Have Changed”—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients

“…Therefore, our results align with previous data on traditional open-surgical approaches for advanced ovarian cancer (Table S3) [17]. Additionally, it has been reported that laparoscopy is a feasible option for SDS [16,29], for which the survival curves of our study were comparable to those described in the literature [20,30,31].…”

“Things Have Changed”—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients

“…Therefore, our results align with previous data on traditional open-surgical approaches for advanced ovarian cancer (Table S3) [17]. Additionally, it has been reported that laparoscopy is a feasible option for SDS [16,29], for which the survival curves of our study were comparable to those described in the literature [20,30,31].…”

Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer

“…The previous study reported similar results. The results of a previous review also concluded that, among women undergoing operative intervention for recurrent ovarian cancer, the proportion of women undergoing complete cytoreductive surgery is independently associated with the overall post-recurrence survival time [17]. In the current study, most of the patients treated with SCS had low WBMTV and low WBTLG.…”

“…Therefore, quantitative metabolic parameters measured on FDG PET/CT at the time of relapse can be good criteria for selecting patients for SCS, and it might be applied to both platinum-sensitive and platinum-resistant patients. Residual disease after SCS is known as one of the main prognostic factors for PRS [17,18]. In the current study, 6 of 26 patients (23%) treated with SCS had microscopic residual disease less than 1 cm in diameter (R1), and there were no patients with macroscopic residual disease (R2).…”

The current role of secondary cytoreductive surgery for recurrent ovarian cancer

“…The impact of optimal CRS on survival was less obvious. Moreover, in another previous systematic review and meta-analysis (23), overall survival was higher after complete than after optimal CRS, whereas larger residual disease was associated with poorer outcome. The difference in impact on survival between complete and optimal secondary CRS may be caused by the fact that residual disease drives an early development of drug resistance or that recurrent disease that cannot be complete resected, even by an expert team, represent an aggressive tumor biology that can cannot be altered by surgery.…”

“Things Have Changed”—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients

“…Therefore, our results align with previous data on traditional open-surgical approaches for advanced ovarian cancer (Table S3) [17]. Additionally, it has been reported that laparoscopy is a feasible option for SDS [16,29], for which the survival curves of our study were comparable to those described in the literature [20,30,31].…”

Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer

“…The previous study reported similar results. The results of a previous review also concluded that, among women undergoing operative intervention for recurrent ovarian cancer, the proportion of women undergoing complete cytoreductive surgery is independently associated with the overall post-recurrence survival time [17]. In the current study, most of the patients treated with SCS had low WBMTV and low WBTLG.…”

“…Therefore, quantitative metabolic parameters measured on FDG PET/CT at the time of relapse can be good criteria for selecting patients for SCS, and it might be applied to both platinum-sensitive and platinum-resistant patients. Residual disease after SCS is known as one of the main prognostic factors for PRS [17,18]. In the current study, 6 of 26 patients (23%) treated with SCS had microscopic residual disease less than 1 cm in diameter (R1), and there were no patients with macroscopic residual disease (R2).…”

The current role of secondary cytoreductive surgery for recurrent ovarian cancer

“…The impact of optimal CRS on survival was less obvious. Moreover, in another previous systematic review and meta-analysis (23), overall survival was higher after complete than after optimal CRS, whereas larger residual disease was associated with poorer outcome. The difference in impact on survival between complete and optimal secondary CRS may be caused by the fact that residual disease drives an early development of drug resistance or that recurrent disease that cannot be complete resected, even by an expert team, represent an aggressive tumor biology that can cannot be altered by surgery.…”

“Things Have Changed”—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients

“…Therefore, our results align with previous data on traditional open-surgical approaches for advanced ovarian cancer (Table S3) [17]. Additionally, it has been reported that laparoscopy is a feasible option for SDS [16,29], for which the survival curves of our study were comparable to those described in the literature [20,30,31].…”

Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer

“…The previous study reported similar results. The results of a previous review also concluded that, among women undergoing operative intervention for recurrent ovarian cancer, the proportion of women undergoing complete cytoreductive surgery is independently associated with the overall post-recurrence survival time [17]. In the current study, most of the patients treated with SCS had low WBMTV and low WBTLG.…”

“…Therefore, quantitative metabolic parameters measured on FDG PET/CT at the time of relapse can be good criteria for selecting patients for SCS, and it might be applied to both platinum-sensitive and platinum-resistant patients. Residual disease after SCS is known as one of the main prognostic factors for PRS [17,18]. In the current study, 6 of 26 patients (23%) treated with SCS had microscopic residual disease less than 1 cm in diameter (R1), and there were no patients with macroscopic residual disease (R2).…”

The current role of secondary cytoreductive surgery for recurrent ovarian cancer

“…The impact of optimal CRS on survival was less obvious. Moreover, in another previous systematic review and meta-analysis (23), overall survival was higher after complete than after optimal CRS, whereas larger residual disease was associated with poorer outcome. The difference in impact on survival between complete and optimal secondary CRS may be caused by the fact that residual disease drives an early development of drug resistance or that recurrent disease that cannot be complete resected, even by an expert team, represent an aggressive tumor biology that can cannot be altered by surgery.…”