Abstract
Background
The purpose of this study was to observe the role of secondary cytoreductive surgery in platinum-resistant recurrent ovarian cancer (OC) patients.
Methods
We collected data of patients affected by recurrent OC treated between 1995 and 2013. Inclusion criteria were: invasive epithelial OC histologically documented, cytoreductive surgery and platinum-based chemotherapy at first-line treat ment with evidence of complete response to treatment, disease-free interval <6 months, and no concomitant neoplasia. Patients considered susceptible of cytoreductive surgery (group A) were compared with a historical series of patients with similar characteristics but not eligible for surgery (group B).
Results
Of 122 platinum-resistant patients, 18 met the inclusion criteria for the study and were enrolled. They were compared with a historical series of 18 patients not surgically treated with analogous clinical and pathological features. The most frequent sites of relapse included pelvic and aortic lymph nodes (39 %), peritoneum (33 %), bowel (28 %), and pelvis (22 %). A low rate of intraoperative and postoperative complications was reported. No deaths were recorded. Overall survival was significantly longer in cytoreductive group when compared with the control group (P = 0.035). Median overall survival was 44 months. Estimated 5-year overall survival rates were 57 versus 23.5 % for groups A and B, respectively.
Conclusions
Surgery could represent a useful adjunct to chemotherapy in the management of platinum-resistant recurrent OC patients, carefully selected, in highly selected centers. Larger prospective trials are needed to further confirm our experience.
Similar content being viewed by others
References
American Cancer Society: Cancer Facts and Figures 2014. Atlanta: American Cancer Society, 2014.
Salani R, Backes FJ, Fung K, Holschneider CH, Parker LP, Bristow RE, Goff BA. Post treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011;204:466–78.
Rutten MJ, Leeflang MM, Kenter GG, Mol BW, Buist M. Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev. 2014;2:CD009786.
Rettenmaier NB, Rettenmaier CR, Wojciechowski T, Abaid LN, Brown JV III, Micha JP, Goldstein BH. The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review. Br J Cancer. 2010;103:1657–62.
Schorge JO, Wingo SN, Bhore R, Heffernan TP, Lea JS. Secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer. Int J Gynaecol Obstet. 2010;108:123–7.
Frederick PJ, McQuinn L, Milam MR, et al. Preoperative factors predicting survival after secondary cytoreduction for recurrent ovarian cancer. Int J Gynecol Cancer. 2011;21:831–6.
Petrillo M, Fagotti A, Ferrandina G, et al. Ovarian cancer patients with localized relapse: clinical outcome and prognostic factors. Gynecol Oncol. 2013;131:36–41.
Salani R, Santillan A, Zahurak ML, Giuntoli RL 2nd, Gardner GJ, Armstrong DK, Bristow RE. Secondary cytoreductive surgery for localized, recurrent epithelial ovarian cancer: analysis of prognostic factors and survival outcome. Cancer. 2007;109:685–91.
Magrina JF, Cetta RL, Chang YH, Guevara G, Magtibay PM. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy. Gynecol Oncol. 2013;129:336–40.
Fagotti A, Petrillo M, Costantini B, et al. Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: a case series. Gynecol Oncol. 2014;132:303–6.
Gallotta V, Fagotti A, Fanfani F, et al. Laparoscopic surgical management of localized recurrent ovarian cancer: a single-institution experience. Surg Endosc. 2014;28:1808–15.
Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer. 2000;88:144–53.
Tay EH, Grant PT, Gebski V, Hacker NF. Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Obstet Gynecol. 2002;99:1008–13.
Friedman RL, Eisenkop SM, Wang HJ. Secondary cytoreductive surgery for recurrent ovarian cancer. Cancer. 1995;76:1606–14.
Janicke F, Holscher M, Kuhn W, von Hugo R, Pache L, Siewert JR, Graeff H. Radical surgical procedure improves survival time in patients with ovarian cancer. Cancer. 1992;70:2129–36.
Morris M, Gershenson DM, Wharton JT, Copeland LJ, Edwards CL, Stringer CA. Secondary cytoreductive surgery for epithelial ovarian cancer. Gynecol Oncol. 1989;34:334–8.
Markman M, Bookman MA. Second-line treatment of ovarian cancer. Oncologist. 2000;5:26–35.
Naumann RW, Coleman RL. Management strategies for recurrent platinum-resistant ovarian cancer. Drugs. 2011;71:1397–412.
Petrillo M, Pedone Anchora L, Tortorella L, et al. Secondary cytoreductive surgery in patients with isolated platinum-resistant recurrent ovarian cancer: a retrospective analysis. Gynecol Oncol. 2014;134:257–61.
Blanchard P, Plantade A, Pages C, Afchain P, Louvet C, Tournigand C, de Gramont A. Isolated lymph node relapse of epithelial ovarian carcinoma: outcomes and prognostic factors. Gynecol Oncol. 2007;104:41–5.
BenedettiPanici P, Perniola G, Angioli R, et al. Bulky lymph node resection in patients with recurrent epithelial ovarian cancer: impact of surgery. Int J Gynecol Cancer. 2007;17:1245–51.
Santillan A, Karam AK, Li AJ, et al. Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer. Gynecol Oncol. 2007;104:686–90.
Uzan C, Morice P, Rey A, et al. Outcomes after combined therapy including surgical resection in patients with epithelial ovarian cancer recurrence(s) exclusively in lymph nodes. Ann Surg Oncol. 2004;11:658–64.
Ferrandina G, Legge F, Salutari V, Paglia A, Testa A, Scambia G. Impact of pattern of recurrence on clinical outcome of ovarian cancer patients: clinical considerations. Eur J Cancer. 2006;42:2296–302.
Disclosure
All authors declare they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
A. Musella and C. Marchetti have contributed equally to this article.
Rights and permissions
About this article
Cite this article
Musella, A., Marchetti, C., Palaia, I. et al. Secondary Cytoreduction in Platinum-Resistant Recurrent Ovarian Cancer: A Single-Institution Experience. Ann Surg Oncol 22, 4211–4216 (2015). https://doi.org/10.1245/s10434-015-4523-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-4523-2