Operative morbidity following primary and interval debulking surgery for advanced ovarian cancer

Rose, P.G.; Nerenston, S.; Brady, M. F.; Clarke-Pearson, D.; Olt, George J.; Rubin, Stephen C.; Moore, David H.; Small, James

doi:10.1200/jco.2004.22.90140.5010

Cited by 5 publications

(24 citation statements)

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“…We present reasons for exclusion in the Characteristics of excluded studies table. Three randomised controlled trials (RCTs) met all the inclusion criteria (Redman 1994; Van der Burg 1995; Rose 2004). The updated search in 2010 identified 336 references, of which there were 17 possibly relevant articles.…”

Section: Resultsmentioning

confidence: 99%

“…These trials did not agree on the benefit of survival outcomes for women with IDS. Redman 1994 and Rose 2004 showed similar survival rates between women who had IDS and those who had conventional treatment, while Van der Burg 1995 showed significantly longer survival in the IDS group which was still present after a 10-year follow-up.…”

Section: Introductionmentioning

confidence: 88%

“…We are aware of three major randomised controlled trials (RCTs) (Redman 1994; Van der Burg 1995; Rose 2004) which have been conducted to evaluate the survival benefit of IDS in ovarian cancer. These trials did not agree on the benefit of survival outcomes for women with IDS.…”

Section: Introductionmentioning

confidence: 99%

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Interval debulking surgery for advanced epithelial ovarian cancer

Tangjitgamol¹,

Manusirivithaya²,

Laopaiboon³

et al. 2013

Cochrane Database of Systematic Reviews

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Background Interval debulking surgery (IDS), following induction or neoadjuvant chemotherapy, may have a role in treating advanced epithelial ovarian cancer (stage III to IV) where primary debulking surgery is not an option. Objectives To assess the effectiveness and complications of IDS for women with advanced stage epithelial ovarian cancer. Search methods We searched the Cochrane Gynaecological Cancer Group’s Specialised Register to June 2012, the Cochrane Central Register of Controlled Trials (CENTRAL) 2012, Issue 6, MEDLINE to June 2012 and EMBASE to June 2012. Selection criteria Randomised controlled trials (RCTs) comparing survival of women with advanced epithelial ovarian cancer, who had IDS performed between cycles of chemotherapy after primary surgery with survival of women who had conventional treatment (primary debulking surgery and adjuvant chemotherapy). Data collection and analysis Two review authors independently assessed trial quality and extracted data. Searches for additional information from study authors were attempted. We performed meta-analysis of overall and progression-free survival (PFS), using random-effects models. Main results Three RCTs randomising 853 women, of whom 781 were evaluated, met the inclusion criteria. Meta-analysis of three trials for overall survival (OS) found no statistically significant difference between IDS and chemotherapy alone (hazard ratio (HR) = 0.80, 95% confidence interval (CI) 0.61 to 1.06, I2 = 58%). Subgroup analysis for OS in two trials, where the primary surgery was not performed by gynaecologic oncologists or was less extensive, showed a benefit of IDS (HR = 0.68, 95% CI 0.53 to 0.87, I2 = 0%). Meta-analysis of two trials for PFS found no statistically significant difference between IDS and chemotherapy alone (HR = 0.88, 95% CI 0.57 to 1.33, I2 = 83%). Rates of toxic reactions to chemotherapy were similar in both arms (risk ratio = 1.19, 95% CI 0.53 to 2.66, I2 = 0%), but little information was available for other adverse events or quality or life (QoL). Authors’ conclusions We found no conclusive evidence to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in women whose primary surgery was not performed by gynaecologic oncologists or was less extensive. Data on QoL and adverse events were inconclusive.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

See 1 more Smart Citation

Interval debulking surgery for advanced epithelial ovarian cancer

Tangjitgamol¹,

Manusirivithaya²,

Laopaiboon³

et al. 2013

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

“…The main difference between both trials was the chemotherapy regimen with paclitaxelcarboplatin and cisplatin-paclitaxel in the EORTC and GOG trials, respectively. Furthermore, initial surgery had been defined differently-in the EORTC study, primary surgery had not been defined and many more patients with large tumors were included, while in the GOG study, primary surgery included patients with tumors that, despite attempts of aggressive debulking, still had residual tumors of .1 cm (18) . The most acceptable interpretation of both trials is that patients with ovarian cancer should undergo surgery once in a maximum effort to resect the tumor.…”

Section: Therapy Sequencingmentioning

confidence: 99%

Future options for first-line therapy of advanced ovarian cancer

Bois

Pfisterer

2005

Int J Gynecol Cancer

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The current standard of treatment for patients with advanced ovarian cancer has been established in light of the results from various clinical trials. After debulking surgery, a combination of carboplatin and paclitaxel is considered to be the best treatment option in terms of survival and quality of life. However, since most patients on this chemotherapy modality will experience relapse, several studies have explored, and continue to do so, various modifications and alternatives to standard therapy in order to attain improved efficacy. Various modifications of dose, schedule, or route of standard regimens have shown no benefit, apart from intraperitoneal therapy, which has produced mixed results and would benefit from a definitive trial. Studies of maintenance/consolidation therapy have been mainly negative, although a small number of trials have produced enough positive data to prompt two new studies powered to detect survival benefits. Various phase II trials have investigated “targeted therapies,” but until now no positive results have been recorded. Translational studies are needed to identify patients who will benefit from such specific treatment strategies. The current most evaluated modification of standard therapy is the addition of a third non–cross-resistant drug to carboplatin and paclitaxel. Data for the addition of anthracyclines have either been negative (epirubicin) or not yet analyzed (pegylated liposomal doxorubicin), while evaluable data are shortly expected for the addition of topotecan. Data on the addition of gemcitabine are eagerly awaited from two phase III trials.

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“…The main difference between both trials was the chemotherapy regimen with paclitaxel–carboplatin and cisplatin–paclitaxel in the EORTC and GOG trials, respectively. Furthermore, initial surgery had been defined differently—in the EORTC study, primary surgery had not been defined and many more patients with large tumors were included, while in the GOG study, primary surgery included patients with tumors that, despite attempts of aggressive debulking, still had residual tumors of >1 cm ( 18 ) . The most acceptable interpretation of both trials is that patients with ovarian cancer should undergo surgery once in a maximum effort to resect the tumor.…”

Section: Modification Of Platinum–paclitaxelmentioning

confidence: 99%

Future options for first-line therapy of advanced ovarian cancer

Bois¹,

Pfisterer²

2005

Int J Gynecol Cancer

View full text Add to dashboard Cite

The current standard of treatment for patients with advanced ovarian cancer has been established in light of the results from various clinical trials. After debulking surgery, a combination of carboplatin and paclitaxel is considered to be the best treatment option in terms of survival and quality of life. However, since most patients on this chemotherapy modality will experience relapse, several studies have explored, and continue to do so, various modifications and alternatives to standard therapy in order to attain improved efficacy. Various modifications of dose, schedule, or route of standard regimens have shown no benefit, apart from intraperitoneal therapy, which has produced mixed results and would benefit from a definitive trial. Studies of maintenance/consolidation therapy have been mainly negative, although a small number of trials have produced enough positive data to prompt two new studies powered to detect survival benefits. Various phase II trials have investigated "targeted therapies," but until now no positive results have been recorded. Translational studies are needed to identify patients who will benefit from such specific treatment strategies. The current most evaluated modification of standard therapy is the addition of a third non-cross-resistant drug to carboplatin and paclitaxel. Data for the addition of anthracyclines have either been negative (epirubicin) or not yet analyzed (pegylated liposomal doxorubicin), while evaluable data are shortly expected for the addition of topotecan. Data on the addition of gemcitabine are eagerly awaited from two phase III trials.

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Operative morbidity following primary and interval debulking surgery for advanced ovarian cancer

Cited by 5 publications

References 0 publications

Interval debulking surgery for advanced epithelial ovarian cancer

Interval debulking surgery for advanced epithelial ovarian cancer

Future options for first-line therapy of advanced ovarian cancer

Future options for first-line therapy of advanced ovarian cancer

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