The impact of aggressive debulking surgery and cisplatin-based chemotherapy on progression-free survival in stage III and IV ovarian carcinoma.

Abstract

Forty consecutive patients with stage III and IV invasive ovarian carcinoma were treated on a phase II protocol consisting of optimal debulking surgery, induction cisplatin, cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy, 6-month interval laparoscopy, reinduction cisplatin, PAC chemotherapy, and second-look procedure. All 40 patients have either disease progression or have completed the 12-month protocol. Eighty-seven percent of the patients (35) underwent optimal (less than or equal to 2 cm residual) debulking surgery before chemotherapy, in spite of the fact that 50% (20) were referred to Roswell Park Memorial Institute (RPMI) as inoperable after initial surgery elsewhere. There were no postoperative deaths and chemotherapy was started in less than or equal to 14 days in 97% of the patients. Of the 40 patients, 30% (12) achieved a pathologic complete remission (11) or a clinical complete remission (one patient refused second-look surgery). The estimated 3-year survival rate was 62%, but the 3-year progression-free survival rate was only 29%. The median survival time was 48 months. The estimated 3-year progression-free survival rate was 31% for residual disease less than or equal to 2 cm. For the five patients with residual disease greater than 2 cm, four died within 3 years. The median survival time of patients with less than or equal to 2 cm residual disease was 48 months, as compared with 21 months for those with greater than 2 cm residual disease. Although the estimated 3-year survival rate of 62% is noteworthy, the 3-year progression-free survival rate of only 29% is probably indicative that in spite of extensive debulking surgery and cisplatin-based chemotherapy as used in this protocol, the long range proportion of patients "cured" will remain small.

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

“…The prognostic value of complete tumour debulking on the overall survival has been demonstrated in many retrospective analyses (Piver et al, 1988;Covens, 2000;Bristow et al, 2002). On the basis of a recent meta-analysis of 81 cohorts of patients with stage III -IV disease, it was found that for each 10% increase in maximal cytoreduction, there was an associated 5.5% increase in median survival (Bristow et al, 2002).…”

Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma

“…[2][3][4][5][6][7]24,25 For this reason, increasingly radical surgery has been advocated in recent years to eliminate as much residual tumor as possible. 26 The use of rectosigmoid colon resection in the surgical management of patients with advanced ovarian carcinoma with bulky pelvic disease is rational, because the distal sigmoid frequently is involved by direct extension or serosal implantation from epithelial ovarian carcinoma.…”

The Function of COX-2 in Human Ovarian Carcinoma

“…We completely agree that chemotherapy and the extent of surgical therapy are important prognostic factors in ovarian carcinoma that have been identified by several meta-analyses. [2][3][4][5] Based on these results, platinumbased chemotherapy as well as optimal surgical debulking are now established therapeutic strategies for treatment of ovarian carcinoma.…”

“…[2][3][4][5] Thus, the therapeutic concept of extensive surgical de-bulking is relevant only for therapy of advanced ovarian carcinoma. Since we included 30% of patients with stage I or II ovarian carcinomas in our study, cytoreductive therapy could not be separately assessed as an independent factor in multivariate analysis for the whole study sample.…”

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Also, the testicular teratoma 5 showing complete chondrosarcomatous differentiation is an interesting case although the histology shown in the manuscript does not clearly correspond to conventional chondrosarcoma but rather shows additionally undifferentiated mesenchyme. Again, a reinvestigation of the case with currently available tools would be worthwhile, which would allow identification and classification of chondrocyte differentiation.

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