151
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Claussen C, Rody A, Hanker L. Treatment of Recurrent Epithelial Ovarian Cancer. Geburtshilfe Frauenheilkd 2020; 80:1195-1204. [PMID: 33293727 PMCID: PMC7714556 DOI: 10.1055/a-1128-0280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
Epithelial ovarian cancer is the most common cause of death from gynecological tumors. Most patients with advanced ovarian cancer develop recurrence after concluding first-line therapy, making further lines of therapy necessary. The choice of therapy depends on various criteria such as tumor biology, the patient's general condition (ECOG), toxicity, previous chemotherapy, and response to chemotherapy. The platinum-free or treatment-free interval determines the potential response to repeat platinum-based therapy. If patients have late recurrence, i.e. > 6 months after the end of the last platinum-based therapy (i.e., they were previously platinum-sensitive), then they are usually considered suitable for another round of a platinum-based combination therapy. Patients who are not considered suitable for platinum-based chemotherapy are treated with a platinum-free regimen such as weekly paclitaxel, pegylated liposomal doxorubicin (PLD), gemcitabine, or topotecan. Treatment for the patient subgroup which is considered suitable for platinum-based therapy but cannot receive carboplatin due to uncontrollable hypersensitivity reactions may consist of trabectedin and PLD. While the use of surgery to treat recurrence has long been a controversial issue, new findings from the DESKTOP III study of the AGO working group have drawn attention to this issue again, particularly for patients with a platinum-free interval of > 6 months and a positive AGO score. Clinical studies have also shown the efficacy of angiogenesis inhibitors such as bevacizumab and the PARP inhibitors olaparib, niraparib and rucaparib. These drugs have substantially changed current treatment practice and expanded the range of available therapies. It is important to differentiate between purely maintenance therapy after completing CTX, continuous maintenance therapy during CTX, and the therapeutic use of these substances. The PARP inhibitors niraparib, olaparib and rucaparib have already been approved for use by the FDA and the EMA. The presence of a BRCA mutation is a predictive factor for a better response to PARP inhibitors.
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Affiliation(s)
- Carlota Claussen
- Universitätsklinikum Schleswig-Holstein Campus Lübeck, Klinik für Frauenheilkunde und Geburtshilfe, Lübeck, Germany
| | - Achim Rody
- Universitätsklinikum Schleswig-Holstein Campus Lübeck, Klinik für Frauenheilkunde und Geburtshilfe, Lübeck, Germany
| | - Lars Hanker
- Universitätsklinikum Schleswig-Holstein Campus Lübeck, Klinik für Frauenheilkunde und Geburtshilfe, Lübeck, Germany
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152
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Turco LC, Ferrandina G, Vargiu V, Cappuccio S, Fagotti A, Sallustio G, Scambia G, Cosentino F. Extreme complications related to bevacizumab use in the treatment of ovarian cancer: a case series from a III level referral centre and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1687. [PMID: 33490199 PMCID: PMC7812204 DOI: 10.21037/atm-20-4448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In patients undergoing debulking surgery for ovarian cancer (OC), bevacizumab-combined chemotherapy has been reported to be associated with an increased incidence of adverse events (AEs). Reports in the literature have noted the overall morbidity of bevacizumab to be between 3.7% and 9%. The aim of this study is to report uncommon and unusual manifestations of morbidity in surgical cases performed at our third level referral centers for gynecologic oncology. Additionally, we review the rare and severe bevacizumab-related complications that have been described in the literature. We defined as "extreme", the particularly rare and/or severe complications up to determining a life-threatening condition or death, which are related to the use of bevacizumab. A case-series of extreme complications registered at our institutions were reported. In addition, a literature search of the PubMed, MEDLINE and EMBASE electronic databases was performed for this review. The studies collected included: 8 randomized controlled trials (RCT) and 5 prospective observational, 1 prospective phase-IV, 10 prospective phase-II, 2 prospective phase-I, and 20 retrospective studies, as well as 9 case reports. Bevacizumab was administered as primary treatment in adjuvant and neo-adjuvant setting in 16 and 5 studies respectively, as treatment for recurrence in 36 trials, and for secondary cytoreductive surgery (SCS) in 3 studies. The overall population administered with bevacizumab numbered 7,096 women. Extreme complications were observed in 591 patients, with a morbidity rate of the 8.3%. Overall, central nervous system (CNS), cardiovascular, gastrointestinal (GI) and primary infectious complications were seen in 22 patients (0.3%), 261 patients (3.7%), 159 patients (2.2%), and 8 patients (0.13%), respectively. Hemorrhagic and wound complications occurred in 18 women (0.25%), and 112 women (1.6%), respectively. Extreme complications related to the use of bevacizumab are rare, and often go unrecognized. The recognition and immediate management of such rare and life-threatening complications in patients treated at third level referral centers could significantly improve patient survival.
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Affiliation(s)
- Luigi Carlo Turco
- Mater Olbia Hospital, Gynaecology and Breast Unit, Olbia.,Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Gabriella Ferrandina
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Virginia Vargiu
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Serena Cappuccio
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Anna Fagotti
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Giuseppina Sallustio
- Università Cattolica del Sacro Cuore, Roma, Italia.,Department of Radiology and Diagnostic Imaging, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
| | - Giovanni Scambia
- Department of Woman's, Children's and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italia
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153
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Spiliotis J. Hyperthermic intraperitoneal chemotherapy in ovarian cancer: Qui Bono? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1708. [PMID: 33490220 PMCID: PMC7812203 DOI: 10.21037/atm-20-1486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ovarian cancer is a major cause of cancer related-death in women around the world. Recent statistics on the worldwide cancer burden by the International Agency for the research on Cancer revealed ovarian cancer being both the eighth most frequent malignancy in the west countries. Peritoneal metastasis from ovarian cancer is a major challenge in the clinical management. Despite the evidence of the benefit of Intraperitoneal Chemotherapy in ovarian cancer with peritoneal deposits it has not been widely adopted, mainly due to logistical difficulties and less to the logoregional morbidity as pain. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in patients during the end of cytoreductive surgery (CRS) is a more tolerable feasible method with potential advantages as drug distribution, combination with hyperthermia and application before tumor regrowth. The aim of this article is to investigate the potential benefits of HIPEC explains the rationale, data of major clinical trials meta-analyses and recent randomized trial are presented and explains the indications patient selection and the best time to applicate of this aggressive logo regional treatment.
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Affiliation(s)
- John Spiliotis
- European Interbalkan Medical Center, Thessaloniki, Greece
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154
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Xiao L, Tang J, Li W, Xu X, Zhang H. Improved prognosis for recurrent epithelial ovarian cancer by early diagnosis and 125I seeds implantation during suboptimal secondary cytoreductive surgery: a case report and literature review. J Ovarian Res 2020; 13:141. [PMID: 33250044 PMCID: PMC7702710 DOI: 10.1186/s13048-020-00744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
Background Epithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance. Early diagnosis of recurrence is crucial to avoid diffuse dissemination. Failure of traditional treatment in recurrent epithelial ovarian cancer remains a challenge for clinicians. On the other hand, 125I brachytherapy has been accepted as a useful and hopeful treatment for multiple advanced cancers in recent years. However, its success in advanced epithelial ovarian cancer is limited. Here we report a case of recurrent ovarian cancer who had been early diagnosis of isolated recurrence and successfully treated with 125I seeds implantation during suboptimal cytoreductive surgery. Case presentation A 59-year-old woman presented with recurrent epithelial ovarian cancer who have had a history of ovarian cancer stage IIIB and an R0 resection had been achieved nearly 2 years before presented in our hospital. She underwent suboptimal secondary cytoreductive surgery after four cycles of chemotherapy with little effectiveness and severe chemotherapy-related side effects. Approximately 70% of the cancer-bulk was resected during surgery. For residual lesion which fixed around the right ureter and right external iliac vessel, 125I seeds implantation was performed. Postoperatively, the patient was treated with two cycles of combination chemotherapy with paclitaxel and carboplatin. The patient was free of disease at 26 months’ follow-up period. Conclusion In recurrent EOC patients with unresectable isolated lesion, salvage 125I seeds implantation are feasible and may contribute to survival.
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Affiliation(s)
- Lin Xiao
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Junying Tang
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenbo Li
- Department of Nuclear medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuexun Xu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Zhang
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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155
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Estati FL, Pirolli R, de Alencar VTL, Ribeiro ARG, Formiga MN, Torrezan GT, Carraro DM, Guimarães APG, Baiocchi G, da Costa AABA. Impact of BRCA1/2 Mutations on the Efficacy of Secondary Cytoreductive Surgery. Ann Surg Oncol 2020; 28:3637-3645. [PMID: 33221980 DOI: 10.1245/s10434-020-09366-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Phase III trials evaluating the role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer have pointed to the importance of patient selection. Two studies showed conflicting results regarding the benefit of SCS in BRCA1/2 mutation carriers. Our aim was to evaluate the impact of SCS on recurrent ovarian cancer according to BRCA1/2 status. METHODS All patients with ovarian carcinoma with platinum-sensitive recurrent disease and tested for BRCA1/2 germline mutations were included. Cox regression and log rank test were used to evaluate the impact of SCS on progression-free survival (PFS) and the influence of BRCA1/2 mutations on the effect of SCS. RESULTS 127 patients were included, 45.6% were treated with SCS and chemotherapy and 54.3% treated with chemotherapy only. Patients treated with SCS were younger, presented better performance status, had lower CA125, and had a longer platinum-free interval. In multivariate analysis SCS was associated with longer PFS (HR 0.42, 95% CI 0.25-0.72, p = 0.002). BRCA1/2 mutations were found in 35 patients (27.5%), and 11.8% of patients were treated with PARP inhibitors. Although not statistically significant, both BRCA1/2 wild type patients (PFS: 21.6 vs 18.4 months; p = 0.114) and BRCA1/2 mutation carriers (PFS: 23.1 vs 18.2 months, p = 0.193) appeared to derive benefit from SCS. DISCUSSION The present study suggests a benefit of SCS irrespective of BRCA1/2 status among patients mostly not treated with PARP inhibitor. Further data on post hoc analysis from the phase III trials are warranted to confirm whether BRCA1/2 mutated patients should be selected for SCS.
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Affiliation(s)
| | - Rafaela Pirolli
- Department of Medical Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | | | - Maria Nirvana Formiga
- Department of Medical Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil.,Department of Oncogenetics, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Dirce Maria Carraro
- Genomics and Molecular Biology Group, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | | | - Glauco Baiocchi
- Department of Gynecology Oncology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
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156
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Marchetti C, Fagotti A, Scambia G, De Felice F. ASO Author Reflections: Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer. Ann Surg Oncol 2020; 28:3264-3265. [PMID: 33123859 DOI: 10.1245/s10434-020-09260-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Claudia Marchetti
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Anna Fagotti
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
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157
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Ayhan A, Akilli H. Prognostic factors associated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in recurrent ovarian cancer. Int J Gynaecol Obstet 2020; 152:202-207. [DOI: 10.1002/ijgo.13410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology Department of Obstetrics and Gynecology Baskent University School of Medicine Ankara Turkey
| | - Huseyin Akilli
- Division of Gynecologic Oncology Department of Obstetrics and Gynecology Baskent University School of Medicine Ankara Turkey
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158
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Marchetti C, Fagotti A, Tombolini V, Scambia G, De Felice F. The Role of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2020; 28:3258-3263. [PMID: 33067742 DOI: 10.1245/s10434-020-09226-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. METHODS The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. RESULTS Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61-0.78; p < 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48-0.66; p < 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78-1.10; p = 0.37), but it was 0.73 (95% CI, 0.59-0.91) in favor of the complete resection subpopulation. CONCLUSION This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
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Affiliation(s)
- Claudia Marchetti
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Anna Fagotti
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
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159
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Kim SI, Lee EJ, Lee M, Chung H, Kim JW, Park NH, Song YS, Kim HS. Recurrence patterns after bevacizumab in platinum-sensitive, recurrent epithelial ovarian cancer. Int J Gynecol Cancer 2020; 30:1943-1950. [DOI: 10.1136/ijgc-2020-001517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022] Open
Abstract
ObjectiveEvidence on recurrence patterns after bevacizumab in epithelial ovarian cancer is still insufficient. The aim of this study was to evaluate recurrence patterns after treatment with bevacizumab as second-line treatment in patients with platinum-sensitive, recurrent epithelial ovarian cancer.MethodsWe retrospectively identified epithelial ovarian cancer patients who relapsed ≥6 months after primary treatment consisting of surgery and platinum-based chemotherapy between January 2008 and June 2019. Only those who received platinum-based doublet chemotherapy with bevacizumab or without bevacizumab as second-line treatment were included (n=192). To adjust confounders, we conducted 1:2 propensity score matching for platinum-free interval and secondary debulking surgery. Imaging studies were performed to locate newly developed or enlarged pre-existing tumors. Recurrence patterns were compared between bevacizumab users (study group) and non-users (control group).ResultsAfter matching, the study group (n=52) and control group (n=104) showed similar baseline clinicopathologic characteristics including platinum-free interval (median (range) 15.3 (6.2–87.3) vs 14.0 (6.2–143.5) months; p=0.29) and patient age at the time of first recurrence (median (range) 55.5 (33.7–72.4) vs 55.0 (35.7–84.2) years; p=0.56). Initially, FIGO stage III disease was the most common in both two groups (55.8% vs 66.3%; p=0.20). Bevacizumab users were less likely to develop disease recurrence in the retroperitoneal lymph nodes (13.5% vs 34.6%; p=0.005), pelvis (17.3% vs 35.6%; p=0.018), and abdomen (40.4% vs 61.5%; p=0.012). However, no difference in distant metastasis was observed between the groups (23.1% vs 24.0%; p>0.99). Multivariate analyses adjusting for stage, histologic type, grade, platinum-free interval, and secondary debulking surgery revealed that the use of bevacizumab significantly reduced risks of nodal (adjusted HR (aHR) 0.24; 95% CI 0.10 to 0.56; p=0.001), pelvic (aHR 0.32; 95% CI 0.15 to 0.68; p=0.003), and abdominal recurrences (aHR 0.43; 95% CI 0.26 to 0.71; p=0.001). Nevertheless, use of bevacizumab did not influence risk of distant metastasis (aHR 0.70; 95% CI 0.35 to 1.40; p=0.32).ConclusionsIn patients with platinum-sensitive, recurrent epithelial ovarian cancer, second-line chemotherapy with bevacizumab is associated with reduced risks of nodal, pelvic, and abdominal recurrences, but similar risks of distant metastases.
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160
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Capozzi VA, Rosati A, Turco LC, Sozzi G, Riccò M, Chiofalo B, Vizzielli G. Surgery vs. chemotherapy for ovarian cancer recurrence: what is the best treatment option. Gland Surg 2020; 9:1112-1117. [PMID: 32953626 DOI: 10.21037/gs-20-326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nowadays, the best treatment option for ovarian cancer recurrence is often subjective, can vary in the different centers and depend on personal experience. Arbeitsgemeinschaft Gynaekologische Onkologie (AGO)-DESKTOP studies have identified a population of patients who could benefit from secondary surgery. The results of the Gynecologic Oncology Group (GOG)-0213 study were recently published, which showed no advantage in terms of overall survival (OS) in patients with platinum-sensitive recurrent epithelial ovarian undergoing secondary cytoreductive surgery (SCS) compared to chemotherapy alone. Aim of this narrative review is to summarize the best aspects that can make ovarian cancer recurrence patients suitable for SCS. A narrative review analyzing all the literature of the past 30 years has been performed. PubMed, Scopus, Web of Science and Ovid MEDLINE were used for research. All non-English-language articles have been excluded. The following keywords were searched: 'recurrent ovarian cancer', 'secondary surgery', 'secondary cytoreductive surgery', 'platinum-sensitive ovarian cancer', 'platinum-resistant ovarian cancer'. We divided eligible patients for secondary cytoreduction in relation to the following factors: platinum-sensitivity, AGO-score or Tian model, unresectable lesions, surgical generic contraindication, woman's personal choice. The selection of truly suitable patients for surgery seems an essential requirement for the patient's best therapeutic choice. In case of absent post-surgical residual tumor, good performance status, single recurrence, and platinum-sensitive ovarian recurrence, surgery could be performed.
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Affiliation(s)
| | - Andrea Rosati
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Carlo Turco
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Matteo Riccò
- AUSL-IRCCS di Reggio Emilia-Department of Public Health, Service for Occupational Health and Safety on the Workplaces, Parma, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
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161
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Vergote I, Denys H, De Greve J, Gennigens C, Van De Vijver K, Kerger J, Vuylsteke P, Baurain JF. Treatment algorithm in patients with ovarian cancer. Facts Views Vis Obgyn 2020; 12:227-239. [PMID: 33123697 PMCID: PMC7580261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Most ovarian cancer patients are diagnosed only at advanced stages when survival outcomes are worse, andwhen therapeutic decisions might prove challenging. The fundamental treatment for women with ovarian cancerincludes debulking surgery whenever possible and appropriate systemic therapy (chemotherapy, targeted andantiangiogenic agents). In the last few years, knowledge about histological and molecular characteristics of ovariancancer subtypes and stages has increased considerably. This has enabled the development and improvement ofseveral options for the diagnosis and treatment of ovarian cancer in a patient-tailored approach. Accordingly,therapeutic decisions are guided by the characteristics of the patient and the tumour, especially the molecularfeatures of the cancer subtype and disease stage. Particularly relevant are the advances in early genetic testing ofgermline and somatic mutations involved in DNA repair, and the clinical development of targeted agents. In orderto implement the best individual medical strategies, in this article, we present an algorithm of treatment options,including recently developed targeted agents, for primary and recurrent ovarian cancer patients in Belgium.
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Affiliation(s)
- I Vergote
- Department of Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - H Denys
- Department of Medical Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - J De Greve
- Department of Medical Genetics, University Hospitals Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - C Gennigens
- Department of Medical Oncology, Liège University Hospital, Avenue de l’Hôpital 1, 4000 Liège, Belgium
| | - K Van De Vijver
- Department of Pathology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium,Department of Pathological Anatomy, Antwerp University Hospital, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - J Kerger
- Jules Bordet Institute, Brussels University Hospital,Boulevard de Waterloo 121, 1000 Brussels, Belgium
| | - P Vuylsteke
- Department of Oncology, UCLouvain, CHU UCL Namur Hospital, Site St-Elisabeth, Place Louise Godin 15, 5000 Namur, Belgium
| | - JF Baurain
- Department of Oncology, UCLouvain, CHU UCL Namur Hospital, Site St-Elisabeth, Place Louise Godin 15, 5000 Namur, Belgium,Department of Oncology, St.-Luc University Hospital Brussels, Avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Belgium
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162
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Cytoreductive Surgery for Heavily Pre-Treated, Platinum-Resistant Epithelial Ovarian Carcinoma: A Two-Center Retrospective Experience. Cancers (Basel) 2020; 12:cancers12082239. [PMID: 32785193 PMCID: PMC7464658 DOI: 10.3390/cancers12082239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
Few retrospective studies have shown a benefit in selected patients affected by heavily pre-treated, platinum-resistant ovarian carcinomas (PROCs) who have undergone cytoreduction at relapse. However, the role of tertiary and quaternary cytoreductive surgery is not fully defined. Our aim was to evaluate survival and surgical morbidity and mortality after maximal cytoreduction in this setting. We evaluated all consecutive patients undergoing cytoreduction for platinum-resistance over an 8-year period (2010–2018) in two different centers. Fifty patients (median age 52.5 years, range 34–75) were included; the median number of previous chemotherapy lines was three (range 1–7) and the median number of previous surgeries was one (range 1–4). Completeness of cytoreduction (CC = 0) was achieved in 22 patients (44%). Rates of major operative morbidity and 30-day mortality were 38% and 8%, respectively. Median follow-up was 35 months. The absence of tumor residual (CC = 0) was associated with a significantly better overall survival (OS) compared to the CC > 0 subgroup (median OS 32.9 months (95% CI 21.6–44.2) vs. 4.8 months (95% CI n.a.–9.8), hazard ratio (HR) 4.21 (95% CI 2.07–8.60), p < 0.001). Optimal cytoreduction is feasible and associated with promising OS in selected, heavily pre-treated PROCs. Further prospective studies are required to better define the role of surgery in platinum-resistant disease.
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163
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Uccella S, Franchi MP, Cianci S, Zorzato PC, Bertoli F, Alletti SG, Ghezzi F, Scambia G. Laparotomy vs. minimally invasive surgery for ovarian cancer recurrence: a systematic review. Gland Surg 2020; 9:1130-1139. [PMID: 32953628 DOI: 10.21037/gs-20-353] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of the present review is to thoroughly investigate the role of minimally invasive surgery (MIS) in the setting of secondary cytoreduction for ovarian cancer recurrence, comparing this approach to traditional open surgery. PubMed, ClinicalTrials.gov, Scopus and Web of Science databases (between 1st January 1989 and 1st January 2020), have been systematically queried to identify all articles reporting either laparoscopic or robotic-assisted secondary surgical cytoreduction for recurrent ovarian cancer. We also manually searched the reference lists of the identified studies. Only English language papers were considered. Two independent reviewers screened and identified the reports. A sub-analysis was performed including studies comparing MIS vs. open abdominal secondary cytoreduction. A total of 617 articles were considered. Among them, we included 12 retrospective studies on minimally invasive secondary cytoreduction, enrolling 372 patients (260 of whom were submitted to whether robotics or laparosopy). Three studies compared 69 patients who underwent MIS vs. 112 cases of open abdominal secondary cytoreduction. Other 9 articles described a total of 191 patients who had minimally invasive secondary cytoreduction for recurrent ovarian cancer without a comparative arm. The quality of the evidence was low. The decision regarding the use of MIS was left to surgeon's discretion; in general, the candidates to MIS were selected patients with single-site disease or few localizations of relapse. Compared to open surgery, MIS was associated with significantly lower blood loss, shorter hospital stay and less postoperative complications; the rate of complete cytoreduction to residual tumor =0 was 95.5% in MIS cases vs. 87.5% in laparotomy cases. The risk of complications was generally low. Disease-free and overall survival were comparable between groups. There is no consensus on the criteria to select patients for laparoscopic or robotic secondary cytoreduction. Intra-operative ultrasound has been proposed as a possible tool to better identify the site of recurrence and for confirmation of complete resection of disease. In conclusion, MIS is an option in selected patients with recurrent ovarian cancer, provided there is no widespread disease. Selection of patients appears of utmost importance to obtain satisfactory survival outcomes.
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Affiliation(s)
- Stefano Uccella
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Italy.,Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Stefano Cianci
- Department of Woman Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pier Carlo Zorzato
- Division of Obstetrics and Gynecology, Department of Maternal, Neonatal and Infant Health, ASL Biella, Italy.,Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Francesca Bertoli
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Salvatore Gueli Alletti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Università Cattolica Del Sacro Cuore, Roma, Italy
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164
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Rodriguez J, Fletcher A, Heredia F, Fernandez R, Ramírez Salazar H, Sanabria D, Burbano Luna J, Guerrero E, Pierre M, Rendón GJ, Rosero I, Trujillo LM, Ribeiro R, Baiocchi G, Lopez Blanco A, Malca M, Hoegl J, Borges Garnica A, Lasso de la Vega J, Scasso S, Laufer J, Estrada EE, Gutierrez Criado A, Herbert Nuñez GS, Cantú‐de Leon D, Medina G, Pendola Gómez L, Saadi J, Noll F, Arévalo Sandoval D, Ferreira Oliveira A, Pareja R. Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey. Int J Gynaecol Obstet 2020; 150:368-378. [PMID: 32526044 PMCID: PMC9087623 DOI: 10.1002/ijgo.13272] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Objective To determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID‐19 pandemic among Latin American gynecological cancer specialists. Methods Twelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software. Results A total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post‐cancer treatment follow‐up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo‐oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively). Conclusion Latin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID‐19 pandemic, which may reflect the region’s particularities. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions. The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.
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Affiliation(s)
- Juliana Rodriguez
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | - Angélica Fletcher
- Department of Gynecologic OncologyCentro de Investigaciones Oncológicas Clínica San Diego – CIOSADBogotaColombia
| | - Fernando Heredia
- Department of Gynecology and ObstetricsSchool of MedicineUniversidad de ConcepciónConcepciónChile
| | | | | | - Daniel Sanabria
- Section of Gynecologic OncologyFundación Santa Fe de BogotáBogotáColombia
| | | | - Eduardo Guerrero
- Department of Radiotherapy OncologyInstituto Nacional de CancerologíaBogotaColombia
| | - Marc‐Edy Pierre
- Department of OncologyCentro de InvestigacionesOncológicas Clínica San Diego ‐ CIOSADBogotaColombia
| | - Gabriel J. Rendón
- Department of Gynecologic OncologyInstituto de Cancerología‐Las Américas‐Auna, Hospital GeneralMedellínColombia
| | - Indira Rosero
- Unit of CancerCentro Médico ImbanacoClínica Nuestra Señora de los RemediosCaliColombia
| | - Lina María Trujillo
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
| | - Reitan Ribeiro
- Department of Surgical OncologyErasto Gaertner HospitalCuritibaBrazil
| | - Glauco Baiocchi
- Department of Gynecologic OncologyAC Camargo Cancer CenterSao PauloBrazil
| | - Aldo Lopez Blanco
- Department of Gynecologic surgeryInstituto Nacional de Enfermedades NeoplásicasLimaPerú
| | - Magaly Malca
- Service of Gynecologic OncologyHospital Edgardo Rebagliati MartinsLimaPerú
| | - Jorge Hoegl
- Service of Gynecologic OncologyServicio Oncológico HospitalarioCaracasVenezuela
| | | | | | - Santiago Scasso
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | - Joel Laufer
- Department of Gynecologic OncologyHospital Pereira RossellMontevideoUruguay
| | | | | | | | | | | | - Luis Pendola Gómez
- Service of MastologyION SolcaCentro Oncológico Integral (CENONI)GuayaquilEcuador
| | - José Saadi
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Florencia Noll
- Service of GynecologySection of Gynecologic OncologyHospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | | | - Rene Pareja
- Department of Gynecologic OncologyInstituto Nacional de CancerologíaBogotáColombia
- Clínica de Oncología AstorgaUniversidad Pontificia BolivarianaMedellinColombia
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165
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Paterniti TA, Ahmad S, Holloway RW. Robotic-assisted laparoscopic splenectomy for recurrent ovarian cancer. Int J Gynecol Cancer 2020; 30:1189-1194. [PMID: 32624496 DOI: 10.1136/ijgc-2020-001384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Recurrent ovarian cancer frequently involves the spleen. Our aims were to describe the technique of robotic-assisted laparoscopic splenectomy and to evaluate outcomes including progression-free and overall survival in patients who underwent this procedure for recurrent ovarian cancer. METHODS Chart reviews were performed on all consecutive patients who underwent robotic splenectomy (April 2012 to May 2019) for recurrent ovarian cancer. Patients had ≤3 sites of disease and no ascites. Extent of disease was confirmed by positron emission tomography-computed tomography (PET-CT) pre-operatively and platinum-doublet chemotherapy was initiated post-operatively. Peri- and post-operative outcomes, progression-free survival, and overall survival were assessed. Two video links are included to demonstrate variations in technique and anatomy. RESULTS A total of 10 patients were included. The median age was 63.5 years (range 46-74) and median body mass index was 30 kg/m2 (range 21.5-40.1). Disease was limited to the spleen in seven patients and three had evidence of up to two other sites of disease on imaging. The median robotic splenectomy operative time was 159 min (range 112-214) that included laparoscopic lysis of adhesions prior to robotic port placement in seven cases, and excision of diaphragm or omental implants in three cases. There were no transfusions, laparotomy conversions, return to the operating room, abscesses, or pancreatic pseudocysts. The median length of stay was 2 days (range 1-4). The median time to resumption of chemotherapy was 40 days (range 25-78). After a median follow-up of 51 months (range 12-98), five patients had recurrence (two deaths, three alive with disease), with a median time to recurrence of 14 months (range 12-15). The median progression-free survival was 15 months (range 12-98) and the median overall survival was 51 months (range 12-98) post-splenectomy. CONCLUSIONS Robotic splenectomy was feasible, achieving complete cytoreduction of splenic recurrent ovarian cancer, short hospital length-of-stay, and acceptable morbidity.
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Affiliation(s)
- Thomas A Paterniti
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, Florida, USA.,Florida State University College of Medicine, Orlando, Florida, USA.,Augusta University Medical Center, Department of Obstetrics & Gynecology, Augusta, Georgia, USA
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, Florida, USA .,Florida State University College of Medicine, Orlando, Florida, USA
| | - Robert W Holloway
- Gynecologic Oncology Program, AdventHealth Cancer Institute, Orlando, Florida, USA.,Florida State University College of Medicine, Orlando, Florida, USA
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166
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Bhatt A, Bakrin N, Gertych W, Kammar P, Parikh L, Sheth S, Shaikh S, Devouassoux-Shisheboran M, Glehen O. Extent and distribution of peritoneal disease in patients undergoing cytoreductive surgery for first platinum sensitive recurrence in ovarian cancer and its potential therapeutic implications. Eur J Surg Oncol 2020; 46:2276-2282. [PMID: 32600895 DOI: 10.1016/j.ejso.2020.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Selected patients with platinum sensitive recurrent ovarian cancer may benefit from cytoreductive surgery (CRS). The aim was to study the pattern of peritoneal involvement in these patients that has not been done before. METHODS A comparison was made between the surgical and pathological findings in 60 patients undergoing salvage CRS from July 2018 to December 2019. The sites of residual disease, correlation with surgical and pathological peritoneal cancer index (PCI), small bowel involvement and regional lymph node involvement were studied. RESULTS Fifty-eight (96.6%) had serous carcinoma and 2 (3.4%) clear cell carcinoma. The median surgical PCI (sPCI) was 7 [range 0-27] and median pathological PCI (pPCI) 4 [range 0-21]. CC-0 resection was performed in 81.6%. The upper regions (region 1,2,3) were the commonest sites of residual disease (63.3%) followed by lower regions (region 5,6,7) in 55.0%, middle regions (regions 0,4,8) in 53.3% and small bowel regions (regions 9-12) in 26.6%. Small bowel involvement was associated with a higher sPCI and pPCI (p < 0.001 for both). Regional nodes were involved in 46.6%. A pathological complete response was seen in 8 (13.3%) patients of which 2 had residual disease in regional nodes. Microscopic disease in 'normal appearing' peritoneum was seen in 21%. CONCLUSIONS The parietal peritoneum was the commonest site of recurrence. Small bowel involvement occurred late and was associated with more extensive disease. Regional lymph node involvement was seen nearly 50% and was a common site for occult disease. The role of more extensive parietal peritoneal resection for recurrent disease should be evaluated prospectively.
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Affiliation(s)
- Aditi Bhatt
- Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | - Naoual Bakrin
- Dept. of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Witold Gertych
- Dept. of Obstetrics and Gynecology, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | - Loma Parikh
- Dept. of Pathology, Zydus Hospital, Ahmedabad, India
| | - Sandeep Sheth
- Dept. of Pathology, Zydus Hospital, Ahmedabad, India
| | - Sakina Shaikh
- Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India
| | | | - Olivier Glehen
- Dept. of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France.
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167
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Ogasawara A, Sato S, Hasegawa K. Current and future strategies for treatment of ovarian clear cell carcinoma. J Obstet Gynaecol Res 2020; 46:1678-1689. [PMID: 32578333 DOI: 10.1111/jog.14350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/23/2020] [Indexed: 01/04/2023]
Abstract
Ovarian clear cell carcinoma (OCCC) is one of the five histological types of epithelial ovarian cancer (EOC). OCCC comprises 23% of all EOC cases in Japan, whereas the rate of OCCC in North America and Europe is much lower. OCCC is generally categorized as a rare gynecologic malignancy, and there is limited evidence for specific treatment. The clinical basis for treatment of OCCC is mostly based on retrospective studies, many of which were performed in Japan. Until recently, most randomized clinical trials for EOC have included OCCC; therefore, current treatment for OCCC is basically the same as that for other histologic types of EOC. However, the clinical characteristics of OCCC differ from those of high-grade serous carcinoma, particularly for chemosensitivity, and there is a need to develop new treatment for OCCC. The molecular background of OCCC has unique features: tumors are usually negative for p53 mutations and positive for ARID1A and/or PIK3CA mutations, whereas p53 mutations are common in high-grade serous or endometrioid carcinomas. These features may help in development of new treatment for OCCC. In this review, we described the current evidence for treatment of OCCC, including surgery, radiotherapy, chemotherapy, molecular targeted therapy and immunotherapy, and we discuss ongoing clinical trials and preclinical studies of new treatment approaches for OCCC.
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Affiliation(s)
- Aiko Ogasawara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Sho Sato
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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168
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Lee EK, Matulonis UA. Emerging drugs for the treatment of ovarian cancer: a focused review of PARP inhibitors. Expert Opin Emerg Drugs 2020; 25:165-188. [PMID: 32569489 DOI: 10.1080/14728214.2020.1773791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Poly (ADP-ribose) polymerase (PARP) inhibitors have demonstrated significant anticancer activity in cancers harboring homologous recombination deficiency (HRD), exemplified by high grade serous ovarian cancer (HGSC). PARP inhibitors (PARPi) are being used in women with newly diagnosed ovarian cancer as well as in the recurrent setting. PARPi combination therapies are in development. AREAS COVERED This review discusses the treatment of ovarian cancer, key PARPi clinical trials, mechanisms of action of PARPi, and novel PARPi combination regimens under investigation. PubMed and ClinicalTrials.gov were searched for PARPi trials. Active development was confirmed via PharmaProjects. EXPERT OPINION PARPi have shown to improve progression-free survival (PFS) for women with HGSC as monotherapy in both frontline and recurrent maintenance settings and as monotherapy as treatment for recurrence. These benefits are greatest in HGSC with underlying HRD, in particular for those with deleterious BRCA mutations, and with the least benefit in cancers that are HR proficient (HRP) and BRCA wild-type (wt). Thus far, an improvement in overall survival has only been demonstrated in patients with BRCA mutated EOC treated with olaparib maintenance in the platinum sensitive recurrence setting. Novel combinations of PARPi are undergoing testing in an effort to increase PARPi efficacy in HRP or PARPi-resistant cancers.
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Affiliation(s)
- Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute , Boston, MA, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute , Boston, MA, USA.,Division of Gynecologic Oncology, Dana-Farber Cancer Institute , Boston, MA, USA
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Richardson M, Routson S, Karam A, Dorigo O, Levy K, Renz M, Diver E. The role of asymptomatic screening in the detection of recurrent ovarian cancer. Gynecol Oncol Rep 2020; 33:100595. [PMID: 32548232 PMCID: PMC7286959 DOI: 10.1016/j.gore.2020.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/31/2020] [Indexed: 11/25/2022] Open
Abstract
The pelvic exam was a useful tool in the detection of ovarian recurrence. CA-125 use was not associated with better survival or rate of secondary cytoreductive surgery. Providers should carefully consider modalities for asymptomatic ovarian recurrence monitoring.
Objective To investigate the utility of asymptomatic screening, including CA-125, imaging, and pelvic exam, in the diagnosis and management of recurrent ovarian cancer. Methods Women with ovarian cancer whose cancer recurred after remission were categorized by first method that their provider suspected disease recurrence: CA-125, imaging, symptoms, or physical exam. Differences in clinicopathologic, primary treatment characteristics, and outcomes data including secondary cytoreductive surgery (SCS) outcome and overall survival (OS) were collected. Results 102 patients were identified at our institution from 2003 to 2015. 20 recurrences were detected by symptoms, while 62 recurrences were diagnosed first by asymptomatic rise in CA-125, 5 by pelvic exam, and 15 by imaging in the absence of known exam abnormality or rise in CA-125. Mean time to recurrence was 18.9 months, and median survival was 45.8 months. These did not vary by recurrence detection method (all p > 0.4). Patients whose disease was detected by CA-125 were less likely to undergo SCS than those detected by other means (21.7% vs. 35.0%, p = 0.007). In addition to the 5 patients whose recurrence was detected primarily by pelvic exam, an additional 10 (total n = 15) patients had an abnormal pelvic exam at time of diagnosis of recurrence. Discussion Recurrence detection method was not associated with differing rates of survival or optimal SCS, however those patients detected by CA-125 were less likely to undergo SCS. The pelvic exam was a useful tool for detecting a significant proportion of recurrences.
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Affiliation(s)
| | | | | | | | | | | | - E.J. Diver
- Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University, 900 Blake Wilbur Drive, Palo Alto, CA 94304, USA.
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170
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Bizzarri N, Korompelis P, Ghirardi V, O'Donnell RL, Rundle S, Naik R. Post-operative pancreatic fistula following splenectomy with or without distal pancreatectomy at cytoreductive surgery in advanced ovarian cancer. Int J Gynecol Cancer 2020; 30:1043-1051. [PMID: 32546641 DOI: 10.1136/ijgc-2020-001312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Splenectomy with or without distal pancreatectomy may be necessary at time of cytoreductive surgery to achieve complete cytoreduction in advanced ovarian cancer. However, these procedures have been associated with peri-operative morbidity. The aims of this study were to determine the incidence of distal pancreatectomy among patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer and to determine the incidence, management, treatment, and prognosis of patients with post-operative pancreatic fistula. METHODS Retrospective cohort study of all consecutive patients with FIGO stage IIIC-IVB ovarian, fallopian tube, or primary peritoneal cancer who underwent splenectomy with or without distal pancreatectomy, during primary, interval, or secondary cytoreductive surgery between January 2007 and December 2017. All histologic subtypes were included; patients with borderline ovarian tumor and those undergoing emergency surgery were excluded from analysis. Univariate analyses for survival were generated by Kaplan-Meier survival curves and log-rank (Mantel-Cox) tests for statistical significance. Patients who underwent surgery for recurrence were excluded from survival analysis. Inter-group statistics were performed using Student's t-test for continuous variables, and chi-square test and Fisher's exact test for categorical variables. RESULTS A total of 156/804 (19.4%) women underwent splenectomy, and of these 22 (14.1%) patients had distal pancreatectomy. Of patients who underwent splenectomy only, 2/134 (1.5%) developed grade B post-operative pancreatic fistula and 6/22 (27.3%) patients who underwent distal pancreatectomy developed grade B and C post-operative pancreatic fistula. Five (83.3%) of six of these patients were symptomatic. Distal pancreatectomy patients had a higher risk of developing post-operative pancreatic fistula when compared with patients who underwent splenectomy only (63.7% vs 9.7%, p=0.0001). Median length of hospital stay was longer in patients with post-operative pancreatic fistula: 16.5 (range 7-38) days compared with 10 (range 7-15) days (p=0.019). There was no progression-free survival (p=0.42) and disease-specific survival (p=0.33) difference between patients undergoing splenectomy with or without distal pancreatectomy. CONCLUSION Clinically relevant post-operative pancreatic fistula is a relatively frequent complication (27.3%) following distal pancreatectomy and it is a possible complication after splenectomy only (1.5%).
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy .,Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Porfyrios Korompelis
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Valentina Ghirardi
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy.,Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Rachel Louise O'Donnell
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom.,Newcastle Centre for Gynaecological Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, United Kingdom
| | - Stuart Rundle
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom
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171
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Gu H, Zhou R, Ni J, Xu X, Cheng X, Li Y, Chen X. The value of secondary neoadjuvant chemotherapy in platinum-sensitive recurrent ovarian cancer: a case-control study post GOG-0213 trial. J Ovarian Res 2020; 13:70. [PMID: 32546257 PMCID: PMC7298741 DOI: 10.1186/s13048-020-00673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prognostic value and optimal resection outcome related factors of the secondary cytoreduction surgery (SCR) in Platinum-sensitive recurrent ovarian cancer (PSOC) patients were still in doubt. The present retrospective study aims to determine the relationship between the objective response of secondary neo-adjuvant chemotherapy (SNAC) and the resection outcome of SCR. METHODS Data were reviewed from 142 type II PSOCs who underwent SCR in Jiangsu Institute of Cancer Research between 1996 and 2016. Among them, 55 cases received preliminary Platinum based SNAC before SCR. Logistic regression analysis was used to explore optimal SCR related factors. Cox proportional hazards model and log-rank test were used to assess the associations between the survival durations and covariates. RESULTS Optimal initial CRS (p = 0.02), disappearance of ascites after SNAC (p = 0.04) recurrent status (p = 0.02) and longer Platinum-free interval (p = 0.01) were the independent indicators of optimal SCR. Optimal SCR was associated with time to progression (TTP) but not overall survival (OS) (p = 0.04 and p = 0.41). The TTP and OS of PSOCs underwent SNAC were similar to those patients underwent SCR (p = 0.71, and p = 0.77, respectively) directly. CONCLUSIONS SNAC might be another choice for PSOCs were not suitable for directly SCR. Optimal SCR had survival benefit in PSOCs whenever underwent SNAC or not.
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Affiliation(s)
- Hongyuan Gu
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China.,Nanjing Gaochun People's Hospital, Nanjing, 211300, Jiangsu, P.R. China
| | - Rui Zhou
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China
| | - Jing Ni
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China
| | - Xia Xu
- Department of Chemotherapy, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China
| | - Xianzhong Cheng
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China
| | - Yan Li
- The Medical College of Yangzhou University, Yangzhou, Jiangsu, P.R. China
| | - Xiaoxiang Chen
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, Jiangsu, P.R. China.
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172
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Carrier G, Colombo PE, Mourregot A. Management of diaphragmatic peritoneal metastasis from recurrent ovarian cancer with pericardial invasion. J Visc Surg 2020; 158:89-91. [PMID: 32553557 DOI: 10.1016/j.jviscsurg.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G Carrier
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France.
| | - P E Colombo
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France
| | - A Mourregot
- Department of Surgical Oncology, Cancer Institute of Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier, France
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173
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Marchetti C, Scambia G, Romito A, Fagotti A. Ovarian cancer treatment is evolving: more choices, more chances. Int J Gynecol Cancer 2020; 30:726-727. [DOI: 10.1136/ijgc-2020-001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/04/2022] Open
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174
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Bogani G, Brusadelli C, Guerrisi R, Lopez S, Signorelli M, Ditto A, Raspagliesi F. Gynecologic oncology at the time of COVID-19 outbreak. J Gynecol Oncol 2020; 31:e72. [PMID: 32458597 PMCID: PMC7286755 DOI: 10.3802/jgo.2020.31.e72] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/19/2022] Open
Abstract
The World Health Organization (WHO) classified the novel coronavirus (i.e., coronavirus disease 2019 [COVID-19]) as a global public health emergency. COVID-19 threatens to curtail patient access to evidence-based treatment. Medicine is changing, basically due to the limited available resources. In the field of gynecologic oncology, we have to re-design our treatments' paradigm. During COVID-19 pandemic outbreak, the highest priority is to achieve the maximum benefit from less demanding procedures. Extensive procedures should be avoided, in order to reduce hospitalization and postoperative events that might increase the in-hospital spread of the virus. There are ongoing concerns on the use of laparoscopic procedures, related to the possible contamination of the staff working in the operation room. Other minimally invasive techniques, including, vaginal surgery as well as robotic-assisted and isobaric procedures would be preferred over laparoscopy. A fair allocation of resources is paramount adequate treatments.
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Affiliation(s)
- Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.
| | - Claudia Brusadelli
- Univerity of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Rocco Guerrisi
- Univerity of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Salvatore Lopez
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Mauro Signorelli
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Antonino Ditto
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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175
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Clair KH, Tewari KS. Robotic surgery for gynecologic cancers: indications, techniques and controversies. J Obstet Gynaecol Res 2020; 46:828-843. [PMID: 32410262 DOI: 10.1111/jog.14228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 12/12/2022]
Abstract
Minimally invasive surgery for gynecologic cancers is associated with fewer postoperative complications including less blood loss and quicker recovery time compared to traditional laparotomy. The robotic platform has allowed patients access to minimally invasive surgery due to its increased utilization by gynecologic oncologists. Many surgeons have embraced the robotic platform due to its technological advances over traditional laparoscopy including high-definition 3D optics, wristed instrumentation, camera stability and improved ergonomics. While robotic surgery continues as a mainstay in the management of gynecologic cancers, it remains controversial in regards to its cost effectiveness and more recently, its long-term impact on clinical and oncologic outcomes. A strong component of the justification of this surgical platform is based on extrapolated data from traditional laparoscopy despite limited prospective randomized trials for robotic-assisted surgery. In this review, we highlight the use of robotic surgery in the management of gynecologic cancers in special populations: fertility sparing patients, the morbidly obese, the elderly, and patients with a favorable response to neoadjuvant chemotherapy.
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Affiliation(s)
- Kiran H Clair
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California, USA
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California, USA
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176
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Segura-Sampedro JJ, Morales-Soriano R, Arjona-Sánchez Á, Cascales-Campos P. Secondary surgical cytoreduction needs to be assessed taking into account surgical technique, completeness of cytoreduction, and extent of disease. World J Surg Oncol 2020; 18:92. [PMID: 32393274 PMCID: PMC7216587 DOI: 10.1186/s12957-020-01853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Recent evidence suggested that secondary surgical cytoreduction followed by chemotherapy does not result in longer overall survival in patients with platinum-sensitive recurrent ovarian cancer. This statement is based on a phase III multicenter, randomized clinical trial that lacks a description of the surgical protocol, the surgical technique, and the surgical variables. In a study that evaluates surgical cytoreduction, it is mandatory to assess the grade of cytoreductive surgery achieved (Sugarbaker PH, Langenbeck’s Arch Surg 384:576–87, 1999), the extent of disease using PCI (Peritoneal Cancer Index), the technique itself, and the existence of a multidisciplinary approach with extensive upper abdominal procedures in experienced centers (Ren et al, BMC Cancer 15:1-12, 2015). There is evidence proving that the quality of cytoreduction (Al Rawahi et al, Cochrane Database Syst Rev 2013, 2013), the measurement of the amount of disease by PCI (Elzarkaa et al, J Gynecol Oncol 29, 2018), and a multidisciplinary approach with supramesocolic procedures (Ren et al, BMC Cancer 15:1-12, 2015) impact overall survival. This study fails to compare chemotherapy with secondary cytoreductive surgery since, due to the lack of variables, we can assess neither the performed surgery nor its criteria. This study should not be taken into account to recommend chemotherapy alone over a surgical approach in this group of patients.
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Affiliation(s)
- Juan José Segura-Sampedro
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain. School of Medicine, University of the Balearic Islands (UIB), Palma de Mallorca, Spain.
| | - Rafael Morales-Soriano
- Department of General and Digestive Surgery, Son Espases University Hospital, Spain, 07010 Palma de Mallorca, Spain. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - Álvaro Arjona-Sánchez
- General & Digestive Surgery Department, University Hospital Reina Sofía, School of Medicine, University of Córdoba, Córdoba, Spain
| | - Pedro Cascales-Campos
- General & Digestive Surgery Department, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain
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177
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Shi T, Yin S, Zhu J, Zhang P, Liu J, Zhu Y, Wu S, Chen X, Wang X, Teng Y, Zhu T, Yu A, Zhang Y, Feng Y, Huang H, Bao W, Li Y, Jiang W, Zhang P, Li J, Ai Z, Zhang W, Jia H, Zhang Y, Jiang R, Zhang J, Gao W, Luan Y, Zang R. A phase II trial of cytoreductive surgery combined with niraparib maintenance in platinum-sensitive, secondary recurrent ovarian cancer: SGOG SOC-3 study. J Gynecol Oncol 2020; 31:e61. [PMID: 32319233 PMCID: PMC7189080 DOI: 10.3802/jgo.2020.31.e61] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. METHODS SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography-computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cycles of platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03983226.
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Affiliation(s)
- Tingyan Shi
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Sheng Yin
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianqing Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ping Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jihong Liu
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yaping Zhu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai, China
| | - Sufang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai, China
| | - Xiaojun Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xipeng Wang
- Department of Gynecology and Obstetrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yincheng Teng
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Aijun Yu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yingli Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yanling Feng
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - He Huang
- Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Bao
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai, China
| | - Yanli Li
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai, China
| | - Wei Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Ping Zhang
- Department of Gynecology and Obstetrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiarui Li
- Department of Gynecology and Obstetrics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihong Ai
- Department of Gynecology and Obstetrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Zhang
- Department of Biostatistics, Fudan University, Shanghai, China
| | - Huixun Jia
- Clinical Statistics Center, Shanghai General Hospital, Shanghai, China
| | - Yuqin Zhang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Jiang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiejie Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wen Gao
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yuting Luan
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongyu Zang
- Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
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178
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Kim M, Suh DH, Lee KH, Eom KY, Lee JY, Lee YY, Hansen HF, Mirza MR, Kim JW. Major clinical research advances in gynecologic cancer in 2019. J Gynecol Oncol 2020; 31:e48. [PMID: 32319232 PMCID: PMC7189081 DOI: 10.3802/jgo.2020.31.e48] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 12/13/2022] Open
Abstract
In 2019, 12 topics were selected as the major research advances in gynecologic oncology. Herein, we first opted to introduce the significant clinical activity of pembrolizumab in women with advanced cervical cancer based on the results of the phase 2 KEYNOTE-158 trial. Thereafter, we reviewed 5 topics, including systemic lymphadenectomy in the advanced stage with no gross residual tumor, secondary cytoreductive surgery in recurrent ovarian cancer according to the results of Gynecologic Oncology Group-213 trial, dose-dense weekly paclitaxel scheduling as first-line chemotherapy, the utility of intraperitoneal therapy in the advanced stage, and an update on poly(ADP-ribose) polymerase (PARP) inhibitors for the treatment of ovarian cancer. Additionally, we conducted a thorough review of emerging data from several clinical trials on PARP inhibitors according to drug, target population, and combined usage. For uterine corpus cancer, we reviewed adjuvant therapy for high-risk disease and chemotherapy in advanced/recurrent disease. For the field of radiation oncology, we discussed the utility of neoadjuvant chemotherapy added to chemoradiotherapy and the treatment of radiation-induced cystitis using hyperbaric oxygen. Finally, we discussed the use of individualized therapy with humanized monoclonal antibodies (trastuzumab emtansine and sacituzumab govitecan-hziy) and combination therapy (fulvestrant plus alpesilib, fulvestrant plus anastrozole, and ribociclib plus endocrine therapy) for women with advanced breast cancer.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Keun Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Yun Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hanne Falk Hansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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179
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Glajzer J, Grabowski JP, Sehouli J, Pfisterer J. Recurrent Treatment in Ovarian Cancer Patients: What Are the Best Regimens and the Order They Should Be Given? Curr Treat Options Oncol 2020; 21:49. [PMID: 32350695 DOI: 10.1007/s11864-020-00747-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT The choice of the right treatment regimen for recurrent ovarian cancer (rOC) remains a case-by-case decision. It is based on multiple factors that involve patient characteristics and biological factors at the same time. The prioritization of factors is still subject to changes with a trend towards a more personalized medicine. Therefore, participation and engagement in clinical studies constitutes a substantial need for the future development of the treatment algorithm of rOC.
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Affiliation(s)
- Joanna Glajzer
- Department of Gynecology and Center of Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Jacek P Grabowski
- Department of Gynecology and Center of Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology and Center of Oncological Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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180
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Tewari KS, Monk BJ. Philip John DiSaia, MD: Available Light & The Origin of Storms. J Obstet Gynaecol Res 2020; 46:959-988. [PMID: 32352218 DOI: 10.1111/jog.14277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022]
Abstract
During a career, which spanned nearly 60 years, Professor Philip J. DiSaia (1937-2018) trailblazed a path forward in academic medicine, which would become the standard by which Departments of Obstetrics and Gynecology and Gynecologic Oncology Divisions and Cancer Centers would be measured throughout the United States, in Europe and Japan. Following his discovery of fetal warfarin syndrome as a resident, DiSaia would serve in the U.S. Navy and successfully compete for an American Cancer Society Grant that would fund his Fellowship in Gynecologic Oncology under the instruction of Dr Felix N. Rutledge at the MD Anderson Hospital and Tumor Institute in Houston, Texas. Dr DiSaia's goal to establish a traditional academic department was realized at the University of California, Irvine, where he remained active in an unprecedented, uninterrupted 42-year run, training many outstanding obstetrician-gynecologists and gynecologic oncologists, future Division Directors, Cancer Center Directors and Department Chairpersons. His dedication to the field and inexhaustible work ethic fueled his many successes in tumor immunology and the clinical trials of the National Cancer Institute's Gynecologic Oncology Group.
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Affiliation(s)
- Krishnansu S Tewari
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California, Irvine Medical Center, Orange, California, USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, Arizona, USA
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181
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Glehen O, Kepenekian V, Bouché O, Gladieff L, Honore C. [Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups]. ACTA ACUST UNITED AC 2020; 157:S25-S32. [PMID: 32328206 PMCID: PMC7177067 DOI: 10.1016/j.jchirv.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
La pandémie de COVID-19 modifie profondément l’organisation et l’accès aux soins, en particulier pour les pathologies néoplasiques péritonéales, dont la prise en charge curative mobilise des moyens importants en personnel, bloc opératoire et réanimation. Les groupes BIG-RENAPE et RENAPE proposent des pistes de réflexion et de priorisation pour leur prise en charge. Un renforcement des critères habituels de sélection est nécessaire pour une prise en charge à visée curative : patients jeunes, avec peu de co-morbidités et une extension péritonéale limitée. Il est souhaitable de prioriser les pathologies pour lesquelles la chirurgie de cytoréduction associée ou non à une chimiohyperthermie intrapéritonéale (CHIP) est le traitement de référence et celles pour lesquelles la chimiothérapie systémique ne peut être une alternative temporaire ou prolongée : pseudomyxomes péritonéaux ; mésothéliomes péritonéaux malins résécables ; métastases péritonéales d’origine colorectale si résécables, non répondeuses à la chimiothérapie systémique et/ou après 12 cures, carcinoses ovariennes en 1re intention si résécables et limitées ou en situation intervallaire après un maximum de 6 cycles de chimiothérapie systémique. L’adjonction d’une CHIP devra être discutée au cas par cas, en centre expert. La priorisation des indications devra prendre en considération les conditions locales et la phase de la période épidémique pour permettre une prise en charge péri-opératoire optimale.
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Affiliation(s)
- O Glehen
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.,EA 3738, Université Lyon 1, Lyon, France
| | - V Kepenekian
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France.,EA 3738, Université Lyon 1, Lyon, France
| | - O Bouché
- Service d'hépato-gastro-entérologie et cancérologie digestive, hôpital Robert-Debré, Reims, France
| | - L Gladieff
- Département d'oncologie médicale, institut universitaire du cancer de Toulouse, Toulouse, France
| | - C Honore
- Département de chirurgie, institut Gustave-Roussy, Villejuif, France
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182
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Glehen O, Kepenekian V, Bouché O, Gladieff L, Honore C. Treatment of primary and metastatic peritoneal tumors in the Covid-19 pandemic. Proposals for prioritization from the RENAPE and BIG-RENAPE groups. J Visc Surg 2020; 157:S25-S31. [PMID: 32387058 PMCID: PMC7177076 DOI: 10.1016/j.jviscsurg.2020.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The Covid-19 pandemic is profoundly changing the organization of healthcare access. This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources. The BIG-RENAPE and RENAPE groups have made tentative proposals for prioritizing care provision. A tightening of the usual selection criteria is needed for curative care: young patients with few or no comorbidities and limited peritoneal extension. It is desirable to prioritize disease conditions for which cytoreduction surgery with or without associated hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the gold-standard treatment, and for which systemic chemotherapy cannot be a temporary or long-term alternative: pseudomyxoma peritonei, resectable malignant peritoneal mesotheliomas, peritoneal metastases of colorectal origin if they are resectable and unresponsive to systemic chemotherapy after up to 12 courses, first-line ovarian carcinomatosis if resectable or in interval surgery after at most six courses of systemic chemotherapy. Addition of HIPEC must be discussed case by case in an expert center. The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal peri-operative care.
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Affiliation(s)
- O Glehen
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France; EA 3738, Université Lyon 1, Lyon, France.
| | - V Kepenekian
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud - Hospices Civils de Lyon, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite, France; EA 3738, Université Lyon 1, Lyon, France
| | - O Bouché
- Service d'hépato-gastro-entérologie et cancérologie digestive, hôpital Robert-Debré, Reims, France
| | - L Gladieff
- Département d'oncologie médicale, institut universitaire du cancer de Toulouse, Toulouse, France
| | - C Honore
- Département de chirurgie, institut Gustave-Roussy, Villejuif, France
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183
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Elit L, Pond GR, Levine MN. Routine Imaging or No Routine Imaging, Is That the Question? J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2020.7556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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184
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You B, Robelin P, Tod M, Louvet C, Lotz JP, Abadie-Lacourtoisie S, Fabbro M, Desauw C, Bonichon-Lamichhane N, Kurtz JE, Follana P, Leheurteur M, Piano FD, Ferron G, De Rauglaudre G, Ray-Coquard I, Combe P, Chevalier-Place A, Joly F, Leary A, Pujade-Lauraine E, Freyer G, Colomban O. CA-125 ELIMination Rate Constant K (KELIM) Is a Marker of Chemosensitivity in Patients with Ovarian Cancer: Results from the Phase II CHIVA Trial. Clin Cancer Res 2020; 26:4625-4632. [PMID: 32209570 DOI: 10.1158/1078-0432.ccr-20-0054] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE In patients with ovarian cancer receiving neoadjuvant chemotherapy, the first-line treatment success will depend on both the tumor-primary chemosensitivity and the completeness of interval debulking surgery (IDS). The modeled CA-125 ELIMination rate constant K (KELIM), calculated with the CA-125 longitudinal kinetics during the first 100 chemotherapy days, is a validated early marker of tumor chemosensitivity. The objective was to investigate the role of the chemosensitivity relative to the success of first-line medical-surgical treatment. EXPERIMENTAL DESIGN The CA-125 concentrations were prospectively measured in the randomized phase II trial CHIVA (NCT01583322, carboplatin-paclitaxel regimen ± nintedanib, and IDS, n = 188 patients). The KELIM predictive value regarding the tumor response rate, likelihood of complete IDS, risk of subsequent platinum-resistant relapse (PtRR), progression-free survival (PFS), and overall survival (OS) was assessed using univariate and multivariate tests. RESULTS The data from 134 patients were analyzed. KELIM was an independent and major predictor of subsequent PtRR risk, and of survivals. The final logistic regression model, including KELIM [OR = 0.13; 95% confidence interval (CI), 0.03-0.49] and complete IDS (no vs. yes, OR = 0.30; 95% CI, 0.11-0.76) highlights the preponderant role of chemosensitivity on the success of the first-line treatment. In patients with highly chemosensitive diseases, the patient prognosis was driven more by the chemotherapy-induced antitumor effects than by the surgery. CONCLUSIONS The tumor-primary chemosensitivity, assessed by the modeled CA-125 KELIM calculated during neoadjuvant chemotherapy (http://www.biomarker-kinetics.org/CA-125-neo), may be a major parameter to consider for decision-making regarding IDS attempt, and selecting patients for treatments meant to reverse the primary chemoresistance.See related commentary by May and Oza, p. 4432.
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Affiliation(s)
- Benoit You
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France. .,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Patrick Robelin
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Michel Tod
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Hospices Civils de Lyon, Pharmacie, Hôpital de la Croix Rousse, Lyon, France
| | - Christophe Louvet
- L'Institut Mutualiste Montsouris, Service d'oncologie, GINECO, Paris, France
| | | | - Sophie Abadie-Lacourtoisie
- Institut de Cancérologie de l'Ouest - ICO - Site Paul Papin, Oncologie médicale gynécologique, Angers, GINECO, Paris, France
| | - Michel Fabbro
- ICM Val d'Aurelle Parc Euromedecine, Oncologie médicale, Montpellier, GINECO, Paris, France
| | - Christophe Desauw
- Centre Hospitalier Régional Universitaire de Lille, Oncologie médicale, Lille Cedex, GINECO, Paris, France
| | | | - Jean-Emmanuel Kurtz
- Hôpitaux Universitaires de Strasbourg, Service d'Oncologie et d'Hématologie, Strasbourg, France
| | - Philippe Follana
- CLCC Antoine Lacassagne, Département d'Hématologie - Oncologie médicale, NICE CEDEX 2, GINECO, Paris, France
| | | | - Francesco Del Piano
- Hôpitaux de LEMAN, Chirurgie Gynécologique, THONON LES BAINS, GINECO, Paris, France
| | - Gwénael Ferron
- Institut Claudius Regaud, Département de Chirurgie Oncologique, TOULOUSE, France
| | - Gaëtan De Rauglaudre
- Institut Sainte-Catherine, Oncologie radiothérapie, Avignon, GINECO, Paris, France
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, & Université Claude Bernard Lyon, Lyon, GINECO, Paris, France
| | - Pierre Combe
- Hôpital Européen Georges Pompidou, Oncologie Médicale, GINECO, Paris, France
| | | | - Florence Joly
- Centre François Baclesse, Oncologie Médicale, GINECO, Paris, France
| | | | | | - Gilles Freyer
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France.,Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, Centre Hospitalier Lyon-Sud, GINECO, GINEGEPS, Lyon, France
| | - Olivier Colomban
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Sud, Lyon, France
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185
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Levy T, Migdan Z, Aleohin N, Ben-Shem, Peled O, Tal O, Elyashiv O. Retroperitoneal lymph node recurrence of epithelial ovarian cancer: Prognostic factors and treatment outcome. Gynecol Oncol 2020; 157:392-397. [PMID: 32151375 DOI: 10.1016/j.ygyno.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the treatment outcome and survival of patients with epithelial ovarian cancer recurrence isolated to the retroperitoneal lymph nodes compared to intraperitoneal spread. METHODS A retrospective cohort study including women with recurrence of epithelial ovarian, cancer, who were treated at a single medical center, between 2000 and 2015. Patients were classified into three groups according to the site of recurrence: intraperitoneal only, retroperitoneal lymph nodes only, and both. Response to treatment was assessed by the RECIST criteria. RESULTS Out of 135 patients in our cohort, 66 were diagnosed with intraperitoneal recurrence, 30 with retroperitoneal lymph node recurrence and 39 with combined site recurrence. The clinical, pathological and surgical characteristics were similar among all groups, besides CA-125 which was significantly lower in the retroperitoneal recurrence group at diagnosis, end of treatment and recurrence. The median follow-up period was 45.8 months. Overall survival (OS) and post relapse survival (PRS) were significantly higher in the retroperitoneal recurrence group vs. the intraperitoneal and combined site recurrence groups. (OS - 93.07, 47.9 and 41.7 months, respectively, p < .001, PRS - 68.57, 29.67 and 19.7 months, respectively, p < .001). On cox's regression analysis, retroperitoneal recurrence was found to be an independent prognostic factor for survival. CONCLUSIONS The site of recurrence has significant prognostic value regarding PRS and OS. Patients with recurrence limited to the retroperitoneal lymph nodes have a favourable prognosis with median survival longer than 5 years.
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Affiliation(s)
- T Levy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Z Migdan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Aleohin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben-Shem
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Peled
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Tal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Elyashiv
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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186
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Acosta-Torres S, Fader AN. Laparoscopic splenectomy for secondary cytoreduction of ovarian cancer in a woman with localized splenic recurrence. Gynecol Oncol 2020; 156:744-745. [DOI: 10.1016/j.ygyno.2019.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022]
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187
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188
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Ye S, Zhou S, Chen W, Xiang L, Wu X, Yang H. Recurrence Patterns and Survival Outcomes in Chinese Patients with Surgically Treated Recurrent Ovarian Clear Cell Carcinoma: A Single Institutional Analysis of 45 Cases. Cancer Manag Res 2020; 12:913-919. [PMID: 32104073 PMCID: PMC7012237 DOI: 10.2147/cmar.s242129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background To evaluate the recurrence patterns and survival outcomes of surgically treated relapsed ovarian clear cell carcinoma (OCCC) patients. Methods We performed a comprehensive retrospective analysis of all the patients who underwent secondary debulking from 2004/10 to 2019/04. Results In total, 45 eligible patients were included. 75.6% of the patients had early-stage disease and platinum-sensitive recurrence accounted for 70.5%. The median progression-free survival after primary surgery (PFS 1) was 20 months (range, 2–137). Of all, 64.4% patients had solitary recurrence and 86.7% patients had no residual disease after secondary surgery. Regarding tumor distribution, the most common site was pelvis (47.5%), followed by lymph node metastases (18.0%) and abdominal wall lesions (8.2%). For the entire population, the median disease-free survival after recurrence (PFS 2) and post-relapse survival (PRS) was 15 months (range, 0–96), and 24 months (range, 3–159), respectively. Eight patients (17.8%) had a prolonged PFS2 more than 30 months. Patients with localized relapse had better survival including PFS 2 (P=0.023), PRS (P=0.004), and overall survival (OS) (P=0.029). Patients who achieved complete resection tended to have longer PFS 2 (P=0.017). After multivariate analysis, complete resection at recurrence remained as an independent positive predictor for PFS 2 (P=0.022). The median OS was 50 months and was significantly associated with platinum response (P=0.003) and number of relapsed lesions (P=0.002). Conclusion A high rate of pelvic recurrence was noted in this population. Patients with focal recurrence had a favorable prognosis. Complete resection at secondary debulking proved to be an independent predictor for disease-free survival.
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Affiliation(s)
- Shuang Ye
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Shuling Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Wei Chen
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Department of Obstetrics and Gynecology, Minhang Hospital, Fudan University, The Central Hospital of Minhang District, Shanghai, People's Republic of China
| | - Libing Xiang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Huijuan Yang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
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189
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Gallotta V, Bruno M, Conte C, Giudice MT, Davià F, Moro F, Zannoni GF, Fagotti A, De Bonis M, Capoluongo E, Scambia G, Ferrandina G. Salvage lymphadenectomy in recurrent ovarian cancer patients: Analysis of clinical outcome and BRCA1/2 gene mutational status. Eur J Surg Oncol 2020; 46:1327-1333. [PMID: 32085925 DOI: 10.1016/j.ejso.2020.01.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/28/2019] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study is aimed to analyze the clinical outcome of recurrent ovarian cancer patients bearing isolated lymph-node recurrence (ILNR) who underwent salvage lymphadenectomy (SL). The prognostic role of clinicopathological variables and the mutational status of BRCA1/2 have also been investigated. METHODS This retrospective, single-institutional study included women with platinum-sensitive lymph node recurrence underwent to SL between June 2008 and June 2018. Univariate and multivariate analysis was performed to evaluate the impact of clinical parameters, and BRCA1/2 mutational status on post salvage lymphadenectomy progression-free survival (PSL-PFS). RESULTS As of June 2019, the median follow-up after SL was 30 months, and the relapse has been documented in 48 (56.5%) patients. In the whole series, the median PSL-PFS was 21 months, and the 3-year PSL-PFS was 36.7%. The median PSL-PFS, according to patients with ILNR (N = 71) versus patients with lymph-nodes and other sites of disease (N = 14), was 27 months versus 12 months, respectively. Univariate analysis of variables conditioning PSL-PFS showed that platinum-free interval (PFI) ≥12 months, normal Ca125 serum levels, and number of metastatic lymph-nodes ≤3 played a statistically significant favorable role. In multivariate analysis, PFI duration ≥12 months and the number of metastatic lymph nodes ≤3 were shown to keep their favorable, independent prognostic value on PSL-PFS. CONCLUSIONS In the context of SL, the patients with long PFI and low metastatic lymph node numbers at ILNR diagnosis have the best outcome. The BRCA mutational status seems not associated with clinical variables and PSL-PFS, differently from other sites of disease in ROC patients.
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Affiliation(s)
- V Gallotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy.
| | - M Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - C Conte
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy
| | - M T Giudice
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - F Davià
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - F Moro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy
| | - G F Zannoni
- Università Cattolica Del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Gineco-patologia e Patologia Mammaria, Roma, Italy
| | - A Fagotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - M De Bonis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Polo Scienze per Immagini, di Laboratorio e Infettivologiche, Roma, Italy
| | - E Capoluongo
- Università Federico II-CEINGE, Biotecnologie Avanzate, Napoli, Italy
| | - G Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
| | - G Ferrandina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC di Ginecologia Oncologica, Roma, Italy; Università Cattolica Del Sacro Cuore, Roma, Italy
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190
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Slomovitz B, Gourley C, Carey MS, Malpica A, Shih IM, Huntsman D, Fader AN, Grisham RN, Schlumbrecht M, Sun CC, Ludemann J, Cooney GA, Coleman R, Sood AK, Mahdi H, Wong KK, Covens A, O'Malley DM, Lecuru F, Cobb LP, Caputo TA, May T, Huang M, Siemon J, Fernández ML, Ray-Coquard I, Gershenson DM. Low-grade serous ovarian cancer: State of the science. Gynecol Oncol 2020; 156:715-725. [PMID: 31969252 DOI: 10.1016/j.ygyno.2019.12.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/18/2019] [Accepted: 12/23/2019] [Indexed: 01/01/2023]
Abstract
In January 2019, a group of basic, translational, and clinical investigators and patient advocates assembled in Miami, Florida, to discuss the current state of the science of low-grade serous carcinoma of the ovary or peritoneum-a rare ovarian cancer subtype that may arise de novo or following a diagnosis of serous borderline tumor. The purpose of the conference was to review current knowledge, discuss ongoing research by established researchers, and frame critical questions or issues for future directions. Following presentations and discussions, the primary objective was to initiate future collaborations, uniform database platforms, laboratory studies, and clinical trials to better understand this disease and to advance clinical care outside the boundaries of single academic institutions. This review summarizes the state of the science in five principal categories: epidemiology and patient outcomes, pathology, translational research, patient care and clinical trials, and patients' perspective.
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Affiliation(s)
- Brian Slomovitz
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States.
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - Mark S Carey
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Anais Malpica
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ie-Ming Shih
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rachel N Grisham
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Weil Cornell Medical College, New York, NY, United States
| | - Matthew Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Charlotte C Sun
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jane Ludemann
- Cure Our Ovarian Cancer, cureourovariancancer.org, New Zealand
| | - Gail Austin Cooney
- University of Miami/JFK Medical Center Palm Beach Regional Graduate Medical Education Consortium, Hospice and Palliative Medicine Program, West Palm Beach, FL, United States
| | - Robert Coleman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Haider Mahdi
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, United States; Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Kwong K Wong
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Allan Covens
- University of Toronto, Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, The James CCC at the Wexner Medical Center-The Ohio State University College of Medicine, Columbus, OH, United States
| | - Fabrice Lecuru
- Service de Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen George Pompidou, APHP, Paris, France; Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Lauren P Cobb
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas A Caputo
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, United States
| | - Taymaa May
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Marilyn Huang
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - John Siemon
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | | | - Isabelle Ray-Coquard
- Centre Leon Bèrard, Université Claude Bernard Lyon, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers de l'Ovaire (GINECO), Lyon, France
| | - David M Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Ghirardi V, Moruzzi MC, Bizzarri N, Vargiu V, D'Indinosante M, Garganese G, Pasciuto T, Loverro M, Scambia G, Fagotti A. Minimal residual disease at primary debulking surgery versus complete tumor resection at interval debulking surgery in advanced epithelial ovarian cancer: A survival analysis. Gynecol Oncol 2020; 157:209-213. [PMID: 31952843 DOI: 10.1016/j.ygyno.2020.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To compare survival outcomes and peri-operative complications in patients with advanced ovarian cancer with 1-10 mm residual disease (RD) at primary debulking surgery (PDS) versus those achieving no gross residual disease (NGR) at interval debulking surgery (IDS). METHODS Patients operated with the intent of complete cytoreduction for epithelial ovarian/fallopian tube/primary peritoneal cancer, FIGO stage IIIC-IV, RD 1-10 mm at PDS and NGR at IDS, between 01/2010 and 12/2016, were retrospectively included. All patients had at least 2-years of follow-up completed. RESULTS 207 patients were included (59 PDS and 148 IDS). Patients in PDS group were younger and had a higher surgical complexity score. There was a higher rate of intra- and major early post-operative complications in the group of PDS vs IDS (16.9% vs 1.3% and 28.8% vs 2.0%, p < 0.0001 respectively). After a median follow up of 56.4 months (range 59.2-65.4), 117 (56.5%) patients died of disease in the whole population. Forty-eight (81.4%) patients had progression/recurrent disease in the PDS group and 120 (81.1%) in the IDS group. Median PFS was 16.2 months and 18.9 months for PDS and IDS group, respectively (p = 0.111). Median OS was 41.4 months and 52.4 months for PDS and IDS group, respectively (p = 0.022). CONCLUSIONS IDS should be considered the preferred treatment in case millimetric residual disease is expected at PDS in view of the superimposable PFS and the reduced number of perioperative complications.
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Affiliation(s)
- V Ghirardi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M C Moruzzi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - N Bizzarri
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Vargiu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - M D'Indinosante
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Garganese
- Università Cattolica del Sacro Cuore, Rome, Italy; Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - T Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - M Loverro
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - A Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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192
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Romero D. Prospective evidence discourages secondary cytoreductive surgery. Nat Rev Clin Oncol 2019; 17:68. [PMID: 31804614 DOI: 10.1038/s41571-019-0309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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