Skip to main content

Advertisement

SpringerLink
Log in

Clinical Observations and Outcomes in Advanced Low-Grade Serous Carcinoma of the Ovary: Case Series from a Tertiary Cancer Center

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Low-grade serous carcinoma (LGSC) is a rare histologic subtype of ovarian cancer. We present detailed management of 15 cases of advanced LGSC from a tertiary cancer center of India. Fifteen cases of advanced LGSC who underwent cytoreductive surgery (CRS) were analyzed from a prospectively maintained database. Baseline demographic characteristics, surgical details, and chemotherapy details were recorded. Descriptive statistics were summarized, and progression-free survival (PFS) and overall survival (OS) were estimated. The median age was 37 years. Nine patients had received NACT. All cases were FIGO stage III. Mean PCI was 15. Eleven patients had a completeness of cytoreduction score of 0–1. The median surgical time was 7.5 h; nine patients required multiple gastrointestinal resections. Median blood loss was 2500 ml. Median postoperative ventilation, ICU stay, and hospital stays were 1, 2, and 16 days, respectively. One patient had a grade III complication. Four patients received adjuvant chemotherapy. There was no postoperative mortality at the end of 90 days of surgery. All the patients except one were offered hormonal maintenance therapy. At a median follow-up of 43 months, 4 patients were disease-free, 9 had a recurrence, one died of disease progression, and one was lost to follow-up. Most recurrences were locoregional in the peritoneal cavity or pelvis. Four-year OS and PFS were 71.8% and 29.7%, respectively. Advanced LGSCs occur mostly in young premenopausal women with favorable oncologic outcomes. Optimal CRS is the mainstay of treatment. Relative chemo-resistance and hormone receptor positivity provide an excellent therapeutic opportunity for endocrine therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vineyard MA et al (2011) Is low-grade serous ovarian cancer part of the tumor spectrum of hereditary breast and ovarian cancer? Gynecol Oncol 120(2):229–232. https://doi.org/10.1016/j.ygyno.2010.10.033

    Article  PubMed  Google Scholar 

  2. Malpica A et al (2004) Grading ovarian serous carcinoma using a two-tier system. Am J Surg Pathol 28(4):496–504. https://doi.org/10.1097/00000478-200404000-00009

    Article  PubMed  Google Scholar 

  3. McGee J et al (2017) Fifth Ovarian Cancer Consensus Conference: individualized therapy and patient factors. Ann Oncol 28(4):702–710. https://doi.org/10.1093/ANNONC/MDX010

    Article  CAS  PubMed  Google Scholar 

  4. Kaldawy A, Segev Y, Lavie O, Auslender R, Sopik V, Narod SA (2016) Low-grade serous ovarian cancer: a review. Gynecol Oncol 143(2):433–438. https://doi.org/10.1016/j.ygyno.2016.08.320

    Article  PubMed  Google Scholar 

  5. Amante S, Santos F, Cunha TM (2021) Low-grade serous epithelial ovarian cancer: a comprehensive review and update for radiologists. Insights Imaging 12(1):60. https://doi.org/10.1186/s13244-021-01004-7

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vergote I et al (2018) Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials. Lancet Oncol 19(12):1680–1687. https://doi.org/10.1016/S1470-2045(18)30566-7

    Article  PubMed  Google Scholar 

  7. Sneige N, Thomison JB, Malpica A, Gong Y, Ensor J, Silva EG (2012) Peritoneal washing cytologic analysis of ovarian serous tumors of low malignant potential to detect peritoneal implants and predict clinical outcome. Cancer Cytopathol 120(4):238–244. https://doi.org/10.1002/CNCY.21219

    Article  PubMed  Google Scholar 

  8. Rekhi B et al (2020) Evaluation of cell blocks from effusion specimens in gynecologic oncopathology: an experience of 220 cases, diagnosed at a tertiary cancer referral center. Indian J Pathol Microbiol 63(3):427. https://doi.org/10.4103/IJPM.IJPM_858_19

    Article  PubMed  Google Scholar 

  9. Voutsadakis IA (2021) A systematic review and meta-analysis of hormone receptor expression in low-grade serous ovarian carcinoma. Eur J Obs Gynecol Reprod Biol 256:172–178

    Article  CAS  Google Scholar 

  10. Sundov D et al (2013) P53, MAPK, topoisomerase II alpha and Ki67 immunohistochemical expression and KRAS/BRAF mutation in ovarian serous carcinomas. Diagn Pathol 8(1):1. https://doi.org/10.1186/1746-1596-8-21

    Article  CAS  Google Scholar 

  11. Grabowski JP et al (2016) Operability and chemotherapy responsiveness in advanced low-grade serous ovarian cancer. An analysis of the AGO Study Group metadatabase. Gynecol Oncol 140(3):457–462. https://doi.org/10.1016/J.YGYNO.2016.01.022

    Article  PubMed  Google Scholar 

  12. Gourley C et al (2014) Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian and primary peritoneal low-grade serous carcinomas. Int J Gynecol Cancer 24(9 Suppl 3):S9–S13. https://doi.org/10.1097/IGC.0000000000000257

    Article  PubMed  Google Scholar 

  13. Fagotti A et al (2020) Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850). Int J Gynecol Cancer 30(11):1657–1664. https://doi.org/10.1136/IJGC-2020-001640

    Article  PubMed  Google Scholar 

  14. Schmeler KM et al (2008) Neoadjuvant chemotherapy for low-grade serous carcinoma of the ovary or peritoneum. Gynecol Oncol 108(3):510–514. https://doi.org/10.1016/J.YGYNO.2007.11.013

    Article  CAS  PubMed  Google Scholar 

  15. Colombo N et al (2019) ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 30(5):672–705. https://doi.org/10.1093/annonc/mdz062

    Article  CAS  PubMed  Google Scholar 

  16. Gershenson DM (2016) Low-grade serous carcinoma of the ovary or peritoneum. Ann Oncol 27(Supplement 1):i45–i49. https://doi.org/10.1093/annonc/mdw085

    Article  PubMed  Google Scholar 

  17. Gershenson DM et al (2009) Recurrent low-grade serous ovarian carcinoma is relatively chemoresistant. Gynecol Oncol 114(1):48–52. https://doi.org/10.1016/J.YGYNO.2009.03.001

    Article  PubMed  Google Scholar 

  18. Gershenson DM, Bodurka DC, Coleman RL, Lu KH, Malpica A, Sun CC (2017) Hormonal maintenance therapy for women with low-grade serous cancer of the ovary or peritoneum. J Clin Oncol 35(10):1103–1111. https://doi.org/10.1200/JCO.2016.71.0632

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gershenson DM et al (2012) Hormonal therapy for recurrent low-grade serous carcinoma of the ovary or peritoneum. Gynecol Oncol 125(3):661–666. https://doi.org/10.1016/J.YGYNO.2012.02.037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ceelen W, Demuytere J, de Hingh I (2021) Hyperthermic intraperitoneal chemotherapy: a critical review. Cancers 2021 13(13):3114. https://doi.org/10.3390/CANCERS13133114

    Article  CAS  Google Scholar 

  21. van Driel WJ et al (2018) Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 378(3):230–240. https://doi.org/10.1056/nejmoa1708618

    Article  CAS  PubMed  Google Scholar 

  22. Sugarbaker PH (2006) New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 7(1):69–76. https://doi.org/10.1016/S1470-2045(05)70539-8

    Article  PubMed  Google Scholar 

  23. Dalton HJ, Fleming ND, Sun CC, Bhosale P, Schmeler KM, Gershenson DM (2017) Activity of bevacizumab-containing regimens in recurrent low-grade serous ovarian or peritoneal cancer: a single institution experience. Gynecol Oncol 145(1):37–40. https://doi.org/10.1016/J.YGYNO.2017.01.027

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Monk BJ et al (2020) MILO/ENGOT-ov11: Binimetinib versus physician’s choice chemotherapy in recurrent or persistent low-grade serous carcinomas of the ovary, fallopian tube, or primary peritoneum. J Clin Oncol 38(32):3753–3762. https://doi.org/10.1200/JCO.20.01164

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Gershenson DM, Gourley C, Paul J (2020) ‘MEK inhibitors for the treatment of low-grade serous ovarian cancer: expanding therapeutic options for a rare ovarian cancer subtype’. 38(32):3731–3734. https://doi.org/10.1200/JCO.20.02190

  26. Mert I et al (2017) Synergistic effect of MEK inhibitor and metformin combination in low grade serous ovarian cancer. Gynecol Oncol 146(2):319–326. https://doi.org/10.1016/J.YGYNO.2017.05.019

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynaecological Oncology Disease Management Group, Tata Memorial Centre, HBNI University, Mumbai, India

    Biswajit Dash, T. S. Shylasree, Bharat Rekhi, Seema Gulia, Jaya Ghosh, Amita Maheshwari, Akshay Patil, Nilesh Sable & Sudeep Gupta

  2. Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB252ZN, UK

    T. S. Shylasree

Authors
  1. Biswajit Dash
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. S. Shylasree
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bharat Rekhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seema Gulia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jaya Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Amita Maheshwari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akshay Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nilesh Sable
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sudeep Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. S. Shylasree.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dash, B., Shylasree, T.S., Rekhi, B. et al. Clinical Observations and Outcomes in Advanced Low-Grade Serous Carcinoma of the Ovary: Case Series from a Tertiary Cancer Center. Indian J Surg Oncol 14, 784–792 (2023). https://doi.org/10.1007/s13193-023-01775-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-023-01775-z

Keywords

Search

Navigation