Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer

Abstract

BACKGROUND.The objective of this study was to evaluate the role of secondary cytoreductive surgery in the outcome of patients who had recurrent epithelial ovarian carcinoma that was limited to ≤5 recurrence sites within the abdomen or pelvis on preoperative imaging studies and attempt to define selection criteria associated with improved survival, with specific attention to the number of lesions suspicious for recurrent disease.METHODS.Patients who underwent secondary surgical cytoreduction for recurrent epithelial ovarian cancer between September 1997 and March 2005 were identified retrospectively from tumor registry databases. Study inclusion criteria required a complete clinical response to primary therapy, ≥12 months between initial diagnosis and recurrence, and ≤5 recurrence sites on preoperative imaging studies. Univariate and multivariate logistic regression analyses were used to evaluate the effect of clinicopathologic variables on overall postrecurrence survival.RESULTS.Fifty‐five patients met the study inclusion criteria. The median patient age at recurrence was 57.7 years, and the median diagnosis‐to‐recurrence interval was 32 months (range, 12–164 months). Complete cytoreduction was achieved in 41 patients (74.5%). On multivariate analysis, the statistically significant and independent predictors of overall survival were a diagnosis‐to‐recurrence interval ≥18 months (median survival, 49 months vs 3 months; P < .01), the number of radiographic recurrence sites (median survival, 50 months for patients with 1 or 2 sites vs 12 months for patients with 3 to 5 sites; P < .03), and residual disease (median survival, 50 months for patients with no macroscopic residual disease vs 7.2 months for patients with macroscopic residual disease; P < .01). Age, tumor grade, histology, CA‐125 level, ascites, and tumor size were not associated significantly with survival.CONCLUSIONS.The current data supported the definition of localized recurrent ovarian cancer as patients with 1 or 2 radiographic recurrence sites. In this select population, a diagnosis‐to‐recurrence interval ≥18 months and complete secondary surgical cytoreduction, which was achievable in the majority of patients, were associated with a median postrecurrence survival of approximately 50 months. Cancer 2007. © 2007 American Cancer Society.

Maximal cytoreductive effort in epithelial ovarian cancer surgery

“…28 Subsequently, other definitions of residual disease have been shown to be associated with a significant survival benefit including 2 cm, 29-32 1 cm, 33-37 5 mm, [38][39][40] and no gross residual disease. [41][42][43][44][45][46][47][48][49][50][51][52] A recent meta-analysis of 40 studies on cytoreductive surgery in recurrent EOC included 2,019 patients. 53 The median diseasefree interval (DFI) was 20.2 months and median survival after recurrence was 30.3 months.…”

“…In several studies on secondary cytoreduction, other clinical variables were found to be independently associated with survival on multivariate analysis. These include age, 41,51 initial stage (IIIC vs. IV), 41 ascites ≤1 liter, 41 histology (all other vs mucinous/clear cell), 41 disease-free interval ＞12 months, 48 limited sites (1-2) of recurrence, 48,50 tumor size ＜6 cm, 48 diagnosis to recurrence time ＞18 months, 50 and treatment-free interval ＜24 months. 51 Patient selection is critical in determining candidates for secondary cytoreduction.…”

Impact of FDG PET in optimizing patient selection for cytoreductive surgery in recurrent ovarian cancer

“…The treatment-free interval prior to secondary cytoreductive surgery and residual disease after it have been demonstrated to be associated with better outcome. [1,2] However, the ratio of patients with optimal resection is as low as 70%. [3] This might be due to the difficulty of predicting the possibility of attaining optimal cytoreduction.…”

Human Epididymis Protein 4 (HE4) mRNA as a Prognostic Marker in Ovarian Tumors in Relation to RMI and CA125

“…Greater than 60% of advanced stage patients will develop recurrent disease (Salani et al, 2007). Patients with advanced stage disease have a five year overall survival between 20 and 40%, in stark contrast to the greater than 90% five year overall survival of patients identified and treated with stage I disease (Cannistra, 2004).…”