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Harrison R, Zighelboim I, Cloven NG, Marcus JZ, Coleman RL, Karam A. Secondary cytoreductive surgery for recurrent ovarian cancer: An SGO clinical practice statement. Gynecol Oncol 2021; 163:448-452. [PMID: 34686355 DOI: 10.1016/j.ygyno.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- R Harrison
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I Zighelboim
- Division of Gynecologic Oncology and Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - N G Cloven
- Gynecologist Oncologist, Texas Oncology, Fort Worth Cancer Center, Fort Worth, TX, USA
| | - J Z Marcus
- Rutgers, New Jersey Medical School, Department of Obstetrics, Gynecology and Reproductive Health, Newark, NJ, USA
| | - R L Coleman
- Gynecologic Oncology, US Oncology & US Oncology Research, The Woodlands, TX, USA
| | - A Karam
- Stanford School of Medicine, Stanford, CA, USA.
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Tentes AAK, Korakianitis OS, Kakolyris S, Kyziridis D, Veliovits D, Karagiozoglou C, Sgouridou E, Moustakas K. Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy in Recurrent Ovarian Cancer. TUMORI JOURNAL 2018; 96:411-6. [DOI: 10.1177/030089161009600306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Cytoreductive surgery with perioperative intraperitoneal chemotherapy is another approach for recurrent ovarian cancer. The purpose of the study was to assess the feasibility and the effect of cytoreduction and perioperative intraperitoneal chemotherapy in recurrent ovarian cancer. Patients and methods Twenty-nine women with recurrent ovarian cancer underwent cytoreductive surgery. Clinical variables were correlated to morbidity, hospital mortality, recurrences, and survival. Results Complete cytoreduction was possible in 58.6%. Extensive seeding of the small bowel and distant metastases excluded the possibility of performing complete cytoreduction. Perioperative intraperitoneal chemotherapy was given in 75.9%. Morbidity and hospital mortality rates were subsequently 24.1% and 3.4%. Recurrence was recorded in 48.3%. The extent of peritoneal dissemination was an independent variable of recurrence (P = 0.014). The 5-year survival rate was 30%. The extent of peritoneal dissemination and the completeness of cytoreduction were related to survival (P <05). The completeness of cytoreduction independently influenced survival (P = 0.013). Conclusions Secondary cytoreduction with intraperitoneal chemotherapy is feasible in most women with recurrent ovarian cancer with acceptable morbidity and mortality. Complete cytoreduction is not possible if distant and unresectable metastases are present or if the small bowel is extensively seeded. Long-term survivors are patients with limited peritoneal dissemination who may undergo complete cytoreduction.
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Affiliation(s)
| | - Odysseas S Korakianitis
- Anesthesiology Department, Didimotichon General Hospital Didimotichon, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Dimitrios Kyziridis
- Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dousan Veliovits
- Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Chrysa Karagiozoglou
- Anesthesiology Department, Didimotichon General Hospital Didimotichon, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evanthia Sgouridou
- Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece
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Meier W, du Bois A, Reuss A, Kuhn W, Olbricht S, Gropp M, Richter B, Lück HJ, Kimmig R, Pfisterer J. Topotecan versus treosulfan, an alkylating agent, in patients with epithelial ovarian cancer and relapse within 12 months following 1st-line platinum/paclitaxel chemotherapy. A prospectively randomized phase III trial by the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Cancer Study Group (AGO-OVAR). Gynecol Oncol 2009; 114:199-205. [DOI: 10.1016/j.ygyno.2009.04.026] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Revised: 04/17/2009] [Accepted: 04/20/2009] [Indexed: 10/20/2022]
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Bae J, Lim MC, Choi JH, Song YJ, Lee KS, Kang S, Seo SS, Park SY. Prognostic factors of secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer. J Gynecol Oncol 2009; 20:101-6. [PMID: 19590721 DOI: 10.3802/jgo.2009.20.2.101] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 06/06/2009] [Accepted: 06/09/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify the prognostic factors of secondary cytoreductive surgery on survival in patients with recurrent epithelial ovarian cancer. METHODS The medical records of all patients who underwent secondary cytoreductive surgery between May 2001 and October 2007 at the National Cancer Center, Korea were reviewed. Univariate and multivariate analyses were executed to evaluate the potential variables for overall survival. RESULTS In total, 54 patients met the inclusion criteria. Optimal cytoreduction to <0.5 cm residual disease was achieved in 87% of patients who had received secondary cytoreductive surgery. Univariate analysis revealed that site of recurrence (median survival, 53 months for the largest tumors in the pelvis vs. 24 months for the largest tumors except for the pelvis; p=0.007), progression free survival (PFS) (median survival, 43 months for PFS>/=12 months vs. 24 months for PFS<12 months; p=0.036), and number of recurrence sites (median survival, 49 months for single recurred tumor vs 29 months for multiple recurred tumors; p=0.036) were significantly associated with overall survival. On multivariate analysis, prognostic factors that correlated with improved survival were site of recurrence (p=0.013), and PFS (p=0.043). CONCLUSION In the author's analysis, a significant survival benefit was identified for the recurred largest tumors within the pelvis and PFS>/=12 months. Secondary cytoreductive surgery should be offered in selected patients and large prospective studies are needed to define the selection criteria for secondary cytoreductive surgery.
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Affiliation(s)
- Jaeman Bae
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Seoul, Korea
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Abstract
Imaging has become an essential part of the clinical management of patients with ovarian cancer, contributing to tumor detection, characterization, staging, treatment planning, and follow-up. Imaging findings incorporated into the clinical impression assist in creating a treatment plan specific for an individual patient. Advances in cross-sectional imaging and nuclear medicine (PET) have yielded new insights into the evaluation of tumor prognostic factors. A multimodality approach can satisfy the complex imaging needs of a patient with ovarian cancer; however, the success of such an approach always depends on available resources and on the skills of the physicians involved.
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Affiliation(s)
- Svetlana Mironov
- Department of Radiology, Cornell University Weill Medical College, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Ayhan A, Gultekin M, Taskiran C, Aksan G, Celik NY, Dursun P, Salman MC, Yuce K, Kucukali T. The role of secondary cytoreduction in the treatment of ovarian cancer: Hacettepe University experience. Am J Obstet Gynecol 2006; 194:49-56. [PMID: 16389009 DOI: 10.1016/j.ajog.2005.06.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 05/13/2005] [Accepted: 06/07/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the role of secondary cytoreduction in patients with recurrent epithelial ovarian cancer. STUDY DESIGN Secondarily, cytoreduced patients were retrospectively analyzed with respect to the clinicopathologic variables. RESULTS A total of 64 patients were evaluated in this report. Multivariable analysis revealed 3 factors to be significant: optimal cytoreduction during primary (P = .003, odds ratio [OR]: 0.30; 95% CI: 0.14-0.66), secondary cytoreduction (P = .04, OR: 0.47; 95% CI: 0.22-0.99), and the endometrioid histologic type (P = .005, OR: 0.09; 95% CI: 0.02-0.48). Intrinsic factors of the tumors (grade, stage, age), size, and number of recurrent tumors were nonsignificant. CONCLUSION Secondary cytoreductive surgery should be offered in selected recurrent epithelial ovarian cancer patients. Further prospective randomized series are needed to determine specific recommendations.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey
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Gronlund B, Lundvall L, Christensen IJ, Knudsen JB, Høgdall C. Surgical cytoreduction in recurrent ovarian carcinoma in patients with complete response to paclitaxel-platinum. Eur J Surg Oncol 2005; 31:67-73. [PMID: 15642428 DOI: 10.1016/j.ejso.2004.08.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2004] [Indexed: 11/25/2022] Open
Abstract
AIM The objective was to analyse the impact of secondary cytoreductive surgery in patients with recurrent ovarian carcinoma. METHODS Retrospective review of 572 consecutive patients with primary ovarian carcinoma. Thirty-eight patients with intraabdominal/pelvic recurrence consisted the study group. Clinical variables affecting tumour resectability and survival were evaluated. RESULTS Complete tumour resection was obtained in 42% of patients. A solitary tumour recurrence was independently associated with complete tumour resection (p=0.009). Median survival for patients with complete and incomplete tumour resection was 51.8 and 19.9 months. The parameter, residual tumour, was found independently correlated with survival after the relapse surgical procedure (p=0.02). However, including also the parameter, number of relapse tumour sites, in the multivariate analysis, the parameter, residual tumour, was no longer significantly associated with survival. CONCLUSIONS Complete tumour resection following secondary cytoreductive surgery is associated with improved survival in selected groups of patients with recurrent ovarian cancer. However, other clinical factors than surgical cytoreduction are of considerable significance in determining the outcome of the salvage treatment.
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Affiliation(s)
- B Gronlund
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, DK-2100 Copenhagen, Denmark.
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Bristow RE, del Carmen MG, Pannu HK, Cohade C, Zahurak ML, Fishman EK, Wahl RL, Montz FJ. Clinically occult recurrent ovarian cancer: patient selection for secondary cytoreductive surgery using combined PET/CT. Gynecol Oncol 2003; 90:519-28. [PMID: 13678719 DOI: 10.1016/s0090-8258(03)00336-6] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the utility of combined positron emission tomography/computed tomography (PET/CT) for identifying ovarian cancer tumor masses > or =1 cm in patients with clinically occult recurrent disease by conventional CT imaging. METHODS Twenty-two patients with epithelial ovarian cancer, rising serum CA125 levels, and negative or equivocal conventional CT imaging > or =6 months after primary therapy underwent combined PET/CT imaging followed by surgical reassessment. Fisher's exact test was used to measure the ability of PET/CT to predict macroscopic disease > or =1 cm. RESULTS The median patient age was 55 years, and 91% of patients had FIGO Stage IIIC/IV disease. The median increase in serum CA125 was 24 U/ml (range 10 to 330 U/ml). Conventional CT was reported as negative (n = 15) or equivocal (n = 7) in all cases. Eighteen patients were ultimately found to harbor recurrent ovarian cancer measuring > or =1 cm at the time of surgery, with a median maximal tumor diameter of 2.3 cm (range 1.5 to 3.2 cm). The overall patient-based accuracy of PET/CT in detecting recurrent disease > or =1 cm was 81.8%, with a sensitivity of 83.3% and positive predictive value of 93.8% (P = 0.046). Of patients with recurrent ovarian cancer > or =1 cm, complete cytoreduction to no gross residual tumor was accomplished in 72.2%. CONCLUSION PET/CT imaging demonstrates high sensitivity and positive predictive value in identifying potentially resectable, macroscopic recurrent ovarian cancer among patients with biochemical evidence of recurrence and negative or equivocal conventional CT findings. In appropriately selected patients, early identification of macroscopic recurrent disease may facilitate complete surgical cytoreduction.
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Affiliation(s)
- Robert E Bristow
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Talbot JN, Grahek D, Kerrou K, Younsi N, de Beco V, Colombet-Lamau C, Petegnief Y, Cailleux N, Montravers F. [(18F)-fluoro-2-deoxyglucose PET in imaging of gynecologic cancers]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:775-98. [PMID: 11770272 DOI: 10.1016/s1297-9589(01)00197-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although gynaecological cancers are not currently part of the clinical indications in the French registration for [18F]-fluoro-2-deoxyglucose (FDG), various studies indicate in this context a potential clinical benefit of imaging with this radiopharmaceutical and PET, a new imaging modality that can be performed either with a dedicated machine or with a "hybrid" gamma-camera (CDET). The potential indications of FDG-PET in mammary, ovarian or cervical cancers are reviewed according to the diagnostic phase: screening, tumour characterisation, staging, therapeutic follow-up and search for recurrence. By pooling the published results, the accuracy of FDG-PET could be estimated with a reasonable precision in various clinical settings: characterisation of a breast tumour (598/696 = 86%), lymph node invasion in breast cancer (525/602 = 87%), recurrence of breast cancer (114/127 = 90%), characterisation of adnexal masses (130/176 = 78%), recurrence of ovarian cancer (152/172 = 88%), lymph node invasion in cervical cancer (98/103 = 95%). Authors also present original data concerning their experience of recurrence detection with CDET in breast or ovarian cancers. In 44 patients suspicious of recurrence of breast cancer, FDG-CDET sensitivity was 94%, specificity 82% and accuracy 91%; in 18 patients suspicious of recurrence of ovarian cancer, specificity, sensitivity and accuracy were 100%. The impact of dedicated PET and CDET examinations performed by our team during year 2000, led, according to 63 forms returned to us, to a modification of stage in 48% of breast cancers, 36% of ovarian cancers, 43% of cervical cancers and above all induced a modification in patients' management in respectively 69%, 64% and 60% of cases, more than the average rate in cancer patients which was 50%. No significant difference was observed between clinical impact of dedicated PET and CDET examinations.
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Affiliation(s)
- J N Talbot
- Service de médecine nucléaire, hôpital Tenon, AP-HP, Paris, France
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Abstract
Ovarian cancer spreads early in the disease into the abdomen. An en bloc resection of the tumor, according to surgical principle, is not possible in patients with high-stage ovarian cancer. At surgery, large pelvic tumor lesions are found together with multiple tumor lesions involving the omentum, bowel, and mesentery together with a diffuse peritoneal carcinomatosis and diaphragmatic involvement. A multimodality approach with cytoreductive surgery and taxol platinum-based chemotherapy is therefore the mainstay of treatment of advanced ovarian cancer. The size of residual disease after surgery is one of the most important prognostic factors for survival. Patients with an optimal tumor cytoreduction (residual lesions smaller than 1 cm) have a significant longer survival (almost two times the median survival) than patients with larger residual lesions. This holds true even for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Patients in whom all macroscopic tumor is resected do have the longest survival. The 2-year survival of patients with a radical resection of all macroscopic tumors is 80%, in contrast to less than 22% for the patients with lesions larger than 2 cm. An optimal primary cytoreductive surgery can generally be performed in 30% to 50% of patients. Only in more experienced gynecologic oncology centers is the percentage as high as 85%, but sometimes at the cost of an increased morbidity and even mortality. The worse prognosis of the patients with a suboptimal primary cytoreductive surgery can be improved by an interval cytoreductive surgery after platinum-containing induction chemotherapy. The median survival and progression-free survivals are significantly lengthened by cytoreductive surgery. After more than 5-years follow-up there is still a significant survival benefit: the 5-year survival of the surgery patients was 24% versus 13% for the no-surgery patients (P = 0.0032). All patients, including those with unfavorable prognostic factors (stage IV disease, peritonitis carcinomatosis, or ascites at primary surgery), and even patients with stable disease after induction chemotherapy, seem to benefit from interval cytoreductive surgery. The increase in progression-free survival and overall survival does outweigh the morbidity associated with interval debulking surgery, which is not different from those associated with primary surgery.
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Affiliation(s)
- M E van der Burg
- Department of Medical Oncology, University Hospital Rotterdam Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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