Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis

Harter, P; Hahmann, Maik; Lueck, Hans-Joachim; Poelcher, Martin; Wimberger, Pauline; Ortmann, O.; Canzler, Ulrich; Richter, Barbara; Wagner, Uwe; Hasenburg, Annette; Burges, Alexander; Loibl, S.; Meier, W.; Huober, Jens; Fink, Daniel; Schroeder, W.; Muenstedt, Karsten; Schmalfeldt, Barbara; Emons, Günter; Bois, Andreas du

doi:10.1245/s10434-009-0357-0

Cited by 123 publications

(74 citation statements)

References 27 publications

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“…Other key eligibility criteria included Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 23 ; adequate bone marrow, coagulation, and renal (creatinine 1.5 3 institutional upper limit of normal) and hepatic function; signed informed consent; and deemed resectable to no visible residual disease by the investigator based on selection criteria for secondary cytoreductive surgery. [24][25][26] Patients were ineligible if they met any of the following exclusion criteria: pre-existing neuropathy (National Cancer Institute Common Toxicity Criteria for Adverse Events [NCI-CTCAE] version 3.0) grade >1; known platinum allergy; borderline histology; and other serious disabling diseases that would contraindicate secondary cytoreductive surgery followed by postoperative platinum-based IV chemotherapy.…”

Section: Eligibility Criteriamentioning

confidence: 99%

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

Zivanovic

Abramian

Kullmann

et al. 2014

Intl Journal of Cancer

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This phase I study tested the safety, feasibility, pharmacokinetics and pharmacodynamics of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion (HIPEC) in patients with platinum-sensitive recurrent epithelial ovarian cancer (EOC) undergoing secondary cytoreductive surgery followed by postoperative platinum-based intravenous chemotherapy. Twelve patients with operable, recurrent platinum-sensitive EOC (recurrence !6 months after first-line therapy) were included according to the classical 313 dose-escalation design at three dose levels-60, 80 and 100 mg=m 2 . After surgical cytoreduction, a single dose of cisplatin was administered via HIPEC for 90 min at 41-43 C. Postoperatively, all patients were treated with standard intravenous platinum-based combination chemotherapy. One of six patients experienced a dose-limiting toxicity (grade 3 renal toxicity) at a dose of 100 mg=m 2 . The remaining five patients treated with 100 mg=m 2 tolerated their treatment well. The recommended phase II dose was established at 100 mg=m 2 . The mean peritoneal-to-plasma AUC ratio was 19Á5 at the highest dose level. Cisplatin-induced DNA adducts were confirmed in tumor samples. Common postoperative grade 1-3 toxicities included fatigue, postoperative pain, nausea, and surgical site infection. The ability to administer standard intravenous platinum-based chemotherapy after HIPEC was uncompromised. Cisplatin administered as HIPEC at a dose of 100 mg=m 2 has an acceptable safety profile in selected patients undergoing secondary cytoreductive surgery for platinumsensitive recurrent EOC. Favorable pharmacokinetic and pharmacodynamic properties of HIPEC with cisplatin were confirmed at all dose levels, especially at 100 mg=m 2 . The results are encouraging to determine the efficacy of HIPEC as a complementary treatment in patients with EOC.

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Section: Eligibility Criteriamentioning

confidence: 99%

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

Zivanovic

Abramian

Kullmann

et al. 2014

Intl Journal of Cancer

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“…In the recurrent setting, if certain eligibility criteria like ascites below 500 ml, good performance status, and no residual tumor after primary surgery are met [15,16], a secondary cytoreductive surgery is also associated with significantly improved progression-free and overall survival [17,18]. Hyperthermic intraoperative chemotherapy is also a feasible option in platin-sensitive recurrence [19], survival benefit is being evaluated in ongoing prospective trials [20].…”

Section: Introductionmentioning

confidence: 99%

Total or Subtotal Colectomy in Patients Undergoing Surgery for Primary or Recurrent Epithelial Ovarian Cancer

Oseledchyk

Abramian²,

Kaiser³

et al. 2014

Oncol Res Treat

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Background: There is controversy as to whether performing a total or subtotal colectomy is justified in patients with advanced ovarian cancer, given its potential for morbidity and a negative effect on long-term quality of life. The aim of this study was to assess the perioperative complications, mortality and outcomes of patients who underwent total or subtotal colectomy as part of the surgical procedure for primary or recurrent epithelial ovarian cancer. Patients and Methods: All patients who had undergone surgery including a total or subtotal colectomy for advanced or recurrent ovarian cancer between 2005 and 2013 at our institution were retrospectively identified. Results: In this time period, 339 patients underwent surgery for epithelial ovarian cancer, which in 11 (3%) patients included a total or subtotal colectomy. Severe grade 3-4 postoperative complications occurred in 3 (27%) patients, and 1 (9%) patient died within 60 days of surgery. Conclusion: A total or subtotal colectomy is associated with increased but acceptable morbidity in selected patients undergoing primary cytoreductive surgery. However, in the recurrent/palliative setting, total or subtotal colectomy should be avoided as the prognosis is poor and the morbidity outweighs the clinical benefit.

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“…One of the largest studies conducted on the theme of the influence on survival of the anatomic site of relapse comes from Petrillo et al demonstrating that cases with isolated lymph node recurrences experience a significantly higher overall survival versus cases with isolated peritoneal lesions or versus cases with isolated parenchymatous lesions, with median progression-free survival being 63 versus 41 versus 24 months (11). In the meantime, the presence of peritoneal carcinomatosis has been reported in up to 70% of patients with recurrent disease but failed to be a negative prognostic factor on the overall survival if complete debulking surgery to no residual disease is feasible (18). The benefits of complete cytoreductive surgery at the time of relapse have been best revealed by Bristow et al's meta-analysis, published in 2009, including 2,019 patients from 40 studies.…”

Section: Discussionmentioning

confidence: 99%

Partial Cystectomy for Atypical Isolated Recurrence of Ovarian Adenocarcinoma – A Case Report and Literature Review

Bacalbaşa

Bălescu

2017

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Ovarian cancer remains one of the most common gynecologic malignancies affecting women worldwide and is commonly diagnosed in advanced stages of the disease when disseminated lesions are already present (1). In most of these cases, although the principles of complete cytoreductive surgery are applied, relapse will occur at a certain moment. The standard treatment for these patients has widely varied in the last decades; initially it has been considered that platinum-based chemotherapy should become the standard of care for 'platinum-sensitive' recurrent tumors, while the benefits of secondary cytoreductive surgery have been considered uncertain (2). However, this theory was discarded by studies demonstrating that debulking surgery is able to increase the biological efficacy of chemotherapeutic agents by removing all bulky tumors with poor vascular supply (3). The benefits of secondary cytoreduction at the time of relapse seem to be more evident in cases presenting good performance status, early stage at diagnosis, no residual disease after primary cytoreduction, association of adjuvant chemotherapy, longer disease-free survival, normal cancer antigen (CA)-125 levels, no ascites and isolated recurrences (4-10). The good postoperative outcome reported by patients presenting isolated relapse is mainly explained by the limited number of visceral resections required to obtain complete cytoreduction, transforming these cases in perfect candidates for secondary cytoreduction (11,12). Unfortunately, it is well-known that this eventuality is a rare one as most cases present multiple recurrences necessitating an important visceral sacrifice both in the lower and upper abdomen (13)(14)(15). The aim of this work is to present the case of a 55-yearold patient diagnosed with an atypical, isolated pelvic recurrence invading the urinary bladder removed by performing a partial cystectomy three years after initial diagnosis of ovarian cancer. Case ReportA 55-year-old patient with a medical history of stage IIIC ovarian cancer presented in our service for pelvic pain and macroscopic hematuria. The patient had been submitted to cytoreductive surgery three years before; total hysterectomy with bilateral adnexectomy, pelvic, parietal bilateral peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection. At that moment, an R0 resection was achieved, while the histopathological examination revealed 429 This article is freely accessible online.Correspondence to:

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Surgery for Recurrent Ovarian Cancer: Role of Peritoneal Carcinomatosis: Exploratory Analysis of the DESKTOP I Trial About Risk Factors, Surgical Implications, and Prognostic Value of Peritoneal Carcinomatosis

Abstract: Peritoneal carcinomatosis was a negative predictor for complete resection but had no effect on prognosis if complete resection could be achieved. Improving surgical skills might be one step to increase the proportion of patients who might benefit from surgery for recurrent disease.

Cited by 123 publications

References 27 publications

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

HIPEC ROC I: A phase i study of cisplatin administered as hyperthermic intraoperative intraperitoneal chemoperfusion followed by postoperative intravenous platinum‐based chemotherapy in patients with platinum‐sensitive recurrent epithelial ovarian cancer

Total or Subtotal Colectomy in Patients Undergoing Surgery for Primary or Recurrent Epithelial Ovarian Cancer

Partial Cystectomy for Atypical Isolated Recurrence of Ovarian Adenocarcinoma – A Case Report and Literature Review

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