The clinical outcome of epithelial ovarian cancer patients with apparently isolated lymph node recurrence: A multicenter retrospective Italian study

Kim

International Journal of Gynecological Cancer

et al. 2011

Objectives: To assess and compare the efficacy and toxicity of radiotherapy (RT) versus chemotherapy (CT) in patients with nodal and isolated nonnodal recurrence of ovarian cancer. Methods: Records of 67 patients treated for nodal or isolated nonnodal ovarian cancer recurrence (50 treated with RT and 17 treated with CT) between 2001 and 2010 were retrospectively reviewed. Patients' responses to RT and CT were assessed by the Response Evaluation Criteria in Solid Tumors, and toxicity was evaluated according to the National Cancer Institute Common Toxicity Criteria, version 3.0. Progression-free survival and overall survival were calculated using the Kaplan-Meier method. Results: The overall response rate was 64.0% in the RT group and 16.7% in the CT group (P = 0.003). The median follow-up time was 38 months (range, 3Y97 months) for RT and 18 months (range, 70Y64 months) for CT. The median progression-free survival was 6 months for radiotherapy and 5 months for chemotherapy (P = 0.212). Median overall survival between the 2 groups was not significantly different (P = 0.246). There was no RT-mediated grade 3 or 4 hematologic toxicity, but overall toxicity was not significantly different between the 2 groups. Conclusions: Radiotherapy resulted in a better response and tolerable toxicities compared to CT in patients with either nodal or isolated nonnodal ovarian cancer recurrence. However, progression-free survival and overall survival did not differ between RT and CT. A prospective, multicenter, randomized controlled study is needed to evaluate the survival benefits of RT for ovarian cancer. T he mortality rate of ovarian cancer is higher than that for all other gynecologic cancers, and ovarian cancer is the fifth leading cause of cancer death among women.1 Currently, the standard first-line therapy for advanced ovarian cancer is maximal cytoreductive surgery followed by chemotherapy (CT) with carboplatin plus paclitaxel. 2,3 Despite high initial ORIGINAL STUDY

mentioning

confidence: 99%

Comparison of the Efficacy and Toxicity Between Radiotherapy and Chemotherapy in Nodal and Isolated Nonnodal Recurrence of Ovarian Cancer

Kim

International Journal of Gynecological Cancer

et al. 2011

“…Based on the relevant literature, ILNR occurs in about 4% to 6% of patients with EOC [7,8], and represents approximately 10% of overall recurrences [7]. Although it is relatively rare in EOC, it shows amazingly good survival outcomes [7-12]. No obvious predisposing factors have been reported in association with the occurrence of ILNR.…”

Section: Discussionmentioning

confidence: 99%

“…In observing that some of our patients with ILNR eventually developed peritoneal carcinomatosis after a long follow-up period, a more aggressive treatment should be considered for patients with ILNR. From literature reports on patients with ILNR, survival outcome was found to be longer in cases that underwent surgical removal of metastatic lymph nodes in addition to chemotherapy [10-12]. When possible, surgical removal of metastatic neck lymph nodes in patients with confined pelvic mass during initial surgical intervention of primary tumor would likely result in a higher chance of complete eradication of the cancer.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma

et al. 2013

BackgroundNeck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer. However, ovarian cancer with lymphatic metastasis may manifest a different clinical course from peritoneal carcinomatosis.MethodsThe authors retrospectively assessed 20 patients with EOC and pathologically diagnosed as NLNM between January 2001 and December 2010. The patients were divided into two groups according to the time of NLNM identification. Statistical methods included Kaplan-Meier, log-rank, and Cox regression analysis.ResultsEleven patients were diagnosed with NLNM at the same time of surgical exploration of EOC (Group A) and nine patients at cancer recurrence 43.3 months after initial surgery (Group B). In Group A, patients with tumors confined to the pelvic cavity had no recurrence or had isolated lymph node recurrence (ILNR), and survived longer than patients with abdominal tumor spreading (P = 0.0007). In Group B, 2 patients showed ILNR. The median survival time after NLNM was 42 months in Group A and 6 months in Group B (P = 0.01). Cox model demonstrated that non-serous histology, brain metastasis, and NLNM identified at cancer recurrence were major predictors for poor overall survival (Hazard ratio [HR] = 18.67, 6.93, and 4.52; P = 0.01, 0.02, and 0.04, respectively).ConclusionsA subgroup of EOC patients with NLNM who presented limited pelvic cancer had much better overall survival than patients who had cancer spreading beyond the pelvic cavity or were diagnosed with NLNM at cancer recurrence.

“…Lymph node metastases usually occur concomitantly with peritoneal carcinomatosis or with distant metastases. Isolated inguinal, axillary or supraclavicular lymph node recurrences are anecdotal [11]. Median time to recurrence for patients with early-stage high-risk ovarian cancer and advanced platinum-sensitive disease ranges between 11 and 28 months [9,[12][13][14][15][16][17][18][19].…”

Section: Facts About Recurrent Disease Survival Rates and Salvage Omentioning

confidence: 99%

Optimal follow-up of ovarian cancer patients

Vrdoljak

Miše

Jelavić

et al. 2014

memo

Gynecological malignancies account for roughly 10 % of all cancers in women with ovarian cancer as leading cause of death due to gynecological tumors. Surveillance programs of ovarian cancer are primarily based on recurrence rates, timing of recurrence, salvage options, and chances for cure of patient with recurrence. Since there is no prospective, high evidence data on optimal surveillance program after primary treatment of patients with ovarian cancer recommendations are based on review of retrospective data sets. From all the diagnostic tools available, history taking and clinical examination, including gynecological examination, still contribute to the greatest number of recurrence detections. Radiologic and laboratory tests are usually employed when a suspicion of recurrence is raised.Follow-up plan should be tailored according to the estimated risk of relapse for individual patient.