Secondary Cytoreductive Surgery for Platinum-Sensitive Epithelial Ovarian Cancer
Posted: Friday, June 1, 2018
Complete resection of recurrent tumor at secondary cytoreductive surgery may improve outcomes in some women with epithelial ovarian cancer who have no residuals after primary surgery and have a platinum-sensitive recurrent tumor, according to the results of a Norwegian retrospective study published in Acta Obstetricia et Gynecologica Scandinavica. In addition, Torbjørn Paulsen, PhD, of the Cancer Registry of Norway, Oslo, and colleagues found useful predictors of complete resection at secondary cytoreductive surgery may include a long treatment-free interval and nondisseminated lesions on radiologic images.
The study focused on 397 patients with a primary diagnosis of FIGO (International Federation of Gynecology and Obstetrics) stages I to IV epithelial ovarian cancer who were recorded in the Cancer Registry of Norway between January 2002 and December 2012. All of these women had had primary surgery with no residuals after platinum-based chemotherapy. In addition, they had their first recurrence at least 6 months after completion of primary platinum-based chemotherapy. Then 75 patients had secondary cytoreductive surgery and platinum-based chemotherapy (with complete resection achieved in 60), and 322 patients had platinum-based chemotherapy alone.
The group that received both surgery and chemotherapy demonstrated improved progression-free (hazard ratio, 0.45) and overall (hazard ratio, 0.50) survival compared with the chemotherapy-alone group. In the surgery and chemotherapy group, the median progression-free survival was 2 years and median overall survival was 6 years, compared with 1 year and 2 years, respectively, for the chemotherapy-alone group. Patients with no residuals at secondary surgery were the only ones to reap a survival benefit.
“It is not clear whether the better [overall survival] we observed in the [secondary cytoreductive surgery and platinum-based chemotherapy] group was due to treatment only or also related to tumor biology,” the investigators noted.