Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer

Abstract

Objective The best course of treatment for recurrent ovarian cancer is uncertain. We sought to determine whether secondary cytoreductive surgery for first recurrence of ovarian cancer improves overall survival compared to other treatments. Methods We assessed survival using Surveillance, Epidemiology and End Results-Medicare data for advanced stage ovarian cancer cases diagnosed from January 1, 1997- December 31, 2007 with survival data through 2010 using multinomial propensity weighted finite mixture survival regression models to distinguish true from misclassified recurrences. Of 35,995 women ages 66 years and older with ovarian cancer, 3439 underwent optimal primary debulking surgery with 6 cycles of chemotherapy; 2038 experienced a remission. Results 1635 out of 2038 (80%) women received treatment for recurrence of whom 72% were treated with chemotherapy only, 16% with surgery and chemotherapy and 12% received hospice care. Median survival of women treated with chemotherapy alone, surgery and chemotherapy, or hospice care was 4.1 years, 5.4 years, and 2.2 years, respectively (p<0.001). Of those receiving no secondary treatments, 75% were likely true nonrecurrences with median survival of 15.9 years and 25% misclassified with 2.4 years survival. Survival among women with recurrence was greater for those treated with surgery and chemotherapy compared to chemotherapy alone (HR=1.67; 95% confidence interval: 1.13–2.47). Women who were older with more comorbidities and high grade cancer had worse survival. Conclusions Secondary surgery with chemotherapy to treat recurrent ovarian cancer increases survival by 1.3 years compared to chemotherapy alone and pending ongoing randomized trial results, may be considered a standard of care.

Combined and expanded operations in patients with relapsed ovarian cancer and affected retroperitoneal lymph nodes

“…Роль хирургии в лечении пациенток с рецидивами рака яичников остается одним из наиболее спорных вопросов в онкогинекологии. В ряде ретроспективных и популяционных исследований было показано преимущество при проведении повторной циторедукции [1][2][3].…”

“…По данным анализа результатов лечения 1635 пациенток из базы данных SEER, проведение хирургического лечения с последующей химиотерапией увеличивало медиану общей выживаемости (ОВ) на 1,3 года по сравнению с паллиативной химиотерапией [1]. Однако эти результаты не были подтверждены в рамках проспективных рандомизированных исследований.…”

“…Именно поэтому проведение исследований в отдельных клиниках может быть актуальным, а данные о долгосрочной безрецидивной выживаемости у части пациенток после повторной циторедукции по поводу рецидива рака яичников говорят о необходимости поиска прогностических критериев для оптимального отбора пациенток для подобных вмешательств [1].…”

Which patients benefit from secondary cytoreductive surgery in recurrent ovarian cancer?

“…The first report of secondary cytoreductive surgery was demonstrated by Dr. Berek in 1983 [3]. Then several retrospective studies and few prospective but non-randomized trials were reported [4567]. Four randomized trials were initiated in the 2010s and the patient recruitment lasted for a long period, ranging from 4.5–9.5 years [8].…”

“…The rate of R0 increased from 39.4% (earlier pooled data) to 78.6% (recently closed trial) in non-selected or selected patients with recurrent ovarian cancer [25679]. Neither progression-free survival nor overall survival in GOG 213 was significantly improved in patients who underwent secondary cytoreductive surgery compared to chemotherapy alone [12].…”