Extraperitoneal Metastases From Recurrent Ovarian Cancer

Robinson, William R.; Beyer, J; Griffin, Stephen; Kanjanavaikoon, Paiyarut

doi:10.1097/igc.0b013e31823532ce

Cited by 22 publications

(16 citation statements)

References 16 publications

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“…Other common sites of recurrence include retroperitoneal lymph nodes, upper abdomen, and lungs [6, 7]. Rare sites of recurrence include the brain or presentation as cutaneous lesions [8]. Recently, a study by Tanner et al reported that ovarian cancer patients treated with intravenous chemotherapy tend to recur intra-abdominally (38.6% versus 13.3%, p = 0.006), while those undergoing intra-peritoneal chemotherapy are more likely to recur outside the abdominal cavity (45.5% versus 23.3%, p = 0.018) [9].…”

Section: Introductionmentioning

confidence: 99%

Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Dao

Alwan

Gray

et al. 2013

Gynecologic Oncology

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Objective To evaluate patterns of recurrence for ovarian, fallopian tube, and primary peritoneal cancer patients undergoing extended treatment with bevacizumab (BEV). Methods A retrospective review of patients with primary ovarian, fallopian tube, or peritoneal cancer treated with BEV alone or in combination with other chemotherapy from 2001 to 2011 was performed. Qualified patients were identified by chemotherapy records. Electronic medical records, labs, and imaging reports were reviewed and abstracted. Results Of 108 patients identified, 89 patients met study criteria by having disease progression either during treatment with BEV or after discontinuing BEV without initiating any other treatment. Patients on extended BEV therapy (> 12 cycles) were more likely to recur in extra-visceral sites (p = 0.04), especially in lymph nodes (p = 0.0002), and presented with fewer symptoms at time of recurrence (p = 0.02), compared to patients who had received ≤ 12 cycles. CA-125 becomes less reliable for the detection of recurrent disease with extended BEV therapy (p = 0.03 for ≤ 12 cycles vs. p = 0.08 for >12 cycles). Radiology was superior to CA-125, symptom, and physical exam, in detecting recurrence with extended BEV therapy (all p < 0.0001). Conclusions Extended treatment with BEV in ovarian, fallopian tube, and peritoneal cancers results in alterations in the patterns of recurrence. Radiologic imaging is more reliable than CA-125, symptoms, or physical exam, in identifying recurrent disease in patients undergoing BEV treatment. As novel targeted therapies continue to be employed, guidelines for gynecologic cancer surveillance must continue to be reexamined.

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Section: Introductionmentioning

confidence: 99%

Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Dao

Alwan

Gray

et al. 2013

Gynecologic Oncology

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“…Robinson et al 7 reported that women treated with bevacizumab after intraperitoneal (IP) cisplatin-based chemotherapy were at particularly high risk of extraperitoneal metastases, including in the central nervous system (CNS) and cutaneous tissues. To date, there are limited data on the pattern of recurrence following bevacizumab as frontline therapy, and whether antiangiogenic treatments might enhance distant tumor spread compared with classic chemotherapy regimens or the natural course of the disease is unknown.…”

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confidence: 99%

Patterns of Recurrence in Patients Treated With Bevacizumab in the Primary Treatment of Advanced Epithelial Ovarian Cancer

Rauh-Hain

Guseh

Esselen

et al. 2013

Int J Gynecol Cancer

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“…In assessing the role of specialised surgery for recurrent metastatic ovarian cancer, factors to be considered include-morbidity of surgery, likelihood of resecting disease, likelihood of palliating symptoms by surgical resection, and the patient's prognosis, with and without surgery. There is also some evidence that patients treated with IP chemotherapy and then subsequently with bevacizumab have a greater propensity to develop unusual sites of metastastic recurrence [80]. Patients with a BRCA mutation compared to those who do not have a BRCA mutation more often develop unusual sites of recurrence.…”

Section: Recurrent Ovarian Cancer Outside the Abdomen And Pelvismentioning

confidence: 99%

Surgery for Recurrent Ovarian Cancer

Barton¹

2018

Ovarian Cancer - From Pathogenesis to Treatment

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Most patients with ovarian cancer (OC) have the epithelial subtype (EOC) and present with advanced stage disease. Despite improved surgical and medical management of primary disease, the majority of patients will develop recurrence and ultimately die of disease. The current surgical goal in primary EOC is complete surgical cytoreduction (CSC) as this significantly improves disease-specific survival and overall survival. CSC is a major independent prognostic factor in primary EOC. Recurrent ovarian cancer (ROC) can be diagnosed in the symptomatic or in the asymptomatic patient on clinical evidence, tumour marker results and/or imaging. There are data from cases series and retrospective series on the role of surgery in ROC but there is not yet level I evidence of secondary surgical cytoreduction improving overall survival. The published data emphasise that, as with primary disease, the surgical goal is CSC. In selecting patients for secondary cytoreductive surgery a number of predictive models have been proposed and tested. Patients with ROC who have undergone CSC have a better prognosis than those treated with chemotherapy alone or those in whom the surgical goal was not achieved. The counter-argument is that there is bias in the surgical reports-those patients not operated on chemotherapy alone, or who had incomplete cytoreduction and/or who had chemotherapy had less favourable diseaseassociated and patient-associated factors than those who had CSC. To address these concerns, there are currently three ongoing randomised controlled trials on surgery for ROC.

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Extraperitoneal Metastases From Recurrent Ovarian Cancer

Cited by 22 publications

References 16 publications

Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Recurrence patterns after extended treatment with bevacizumab for ovarian, fallopian tube, and primary peritoneal cancers

Patterns of Recurrence in Patients Treated With Bevacizumab in the Primary Treatment of Advanced Epithelial Ovarian Cancer

Surgery for Recurrent Ovarian Cancer

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