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Gaba F, Blyuss O, Chandrasekaran D, Bizzarri N, Refky B, Barton D, Ind T, Nobbenhuis M, Butler J, Heath O, Jeyarajah A, Brockbank E, Lawrence A, Manchanda R, Dilley J, Phadnis S. Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3484. [PMID: 37998621 PMCID: PMC10670762 DOI: 10.3390/diagnostics13223484] [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: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertiary (TCS) or quaternary (QCS) cytoreduction surgery for recurrence has been suggested to be associated with increased overall survival (OS). We searched five databases for studies reporting death rate, OS, cytoreduction rates, post-operative morbidity/mortality and diagnostic models predicting complete cytoreduction in a platinum-sensitive disease recurrence setting. Death rates calculated from raw data were pooled based on a random-effects model. Meta-regression/linear regression was performed to explore the role of complete or optimal cytoreduction as a moderator. Pooled death rates were 45%, 51%, 66% for SCS, TCS and QCS, respectively. Median OS for optimal cytoreduction ranged from 16-91, 24-99 and 39-135 months for SCS, TCS and QCS, respectively. Every 10% increase in complete cytoreduction rates at SCS corresponds to a 7% increase in median OS. Complete cytoreduction rates ranged from 9-100%, 35-90% and 33-100% for SCS, TCS and QCS, respectively. Major post-operative thirty-day morbidity was reported to range from 0-47%, 13-33% and 15-29% for SCS, TCS and QCS, respectively. Thirty-day post-operative mortality was 0-6%, 0-3% and 0-2% for SCS, TCS and QCS, respectively. There were two externally validated diagnostic models predicting complete cytoreduction at SCS, but none for TCS and QCS. In conclusion, our data confirm that maximal effort higher order cytoreductive surgery resulting in complete cytoreduction can improve survival.
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Affiliation(s)
- Faiza Gaba
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Oleg Blyuss
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child’s Health, Sechenov University, 119435 Moscow, Russia
| | - Dhivya Chandrasekaran
- Department of Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
| | - Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Basel Refky
- Department of Surgical Oncology, Mansoura University, El Mansoura 7650030, Egypt
| | - Desmond Barton
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Thomas Ind
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Marielle Nobbenhuis
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - John Butler
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Owen Heath
- Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - Arjun Jeyarajah
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Elly Brockbank
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Alexandra Lawrence
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - James Dilley
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
| | - Saurabh Phadnis
- Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
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Koufopoulos N, Pouliakis A, Boutas I, Samaras MG, Kontogeorgi A, Dimas D, Sitara K, Zacharatou A, Zanelli M, Palicelli A. Axillary Lymph Node Metastasis from Ovarian Carcinoma: A Systematic Review of the Literature. J Pers Med 2023; 13:1532. [PMID: 38003846 PMCID: PMC10672146 DOI: 10.3390/jpm13111532] [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: 10/01/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Axillary lymph node metastasis is a rare stage IV ovarian carcinoma manifestation. This manuscript aims to systematically review the literature regarding axillary lymph node metastasis from ovarian carcinoma. METHODS We searched three medical internet databases (PubMed, Scopus, and Web of Science) for relevant articles published until 22 July 2023. Cases describing supraclavicular or intramammary lymph node metastases and concurrent metastasis to the breast were excluded. RESULTS After applying eligibility/inclusion and exclusion criteria, twenty-one manuscripts describing twenty-five cases were included from the English literature. Data were collected and analyzed regarding demographic, clinical, laboratory, radiological, histopathological, and oncological characteristics. CONCLUSIONS We analyzed the clinical and oncological characteristics of patients with axillary lymph node metastasis from ovarian carcinoma, presented either as an initial diagnosis of the disease or as a recurrent disease. The analysis we performed showed a significant difference only in the serum CA-125 level (p = 0.004) between the two groups. There was no observed difference in womens' survival.
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Affiliation(s)
- Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (M.G.S.); (A.Z.)
| | - Abraham Pouliakis
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (M.G.S.); (A.Z.)
| | - Ioannis Boutas
- Breast Unit, Rea Maternity Hospital, Palaio Faliro, 17564 Athens, Greece;
| | - Menelaos G. Samaras
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (M.G.S.); (A.Z.)
| | - Adamantia Kontogeorgi
- 3rd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece;
| | - Dionysios Dimas
- Breast Unit, Athens Medical Center, Psychiko Clinic, 11525 Athens, Greece;
| | - Kyparissia Sitara
- Department of Internal Medicine, “Elpis” General Hospital of Athens, 11522 Athens, Greece;
| | - Andriani Zacharatou
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece; (A.P.); (M.G.S.); (A.Z.)
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
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Certelli C, Russo SA, Palmieri L, Foresta A, Pedone Anchora L, Vargiu V, Santullo F, Fagotti A, Scambia G, Gallotta V. Minimally-Invasive Secondary Cytoreduction in Recurrent Ovarian Cancer. Cancers (Basel) 2023; 15:4769. [PMID: 37835463 PMCID: PMC10571765 DOI: 10.3390/cancers15194769] [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: 09/08/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The role of secondary cytoreductive surgery (SCS) in the treatment of recurrent ovarian cancer (ROC) has been widely increased in recent years, especially in trying to improve the quality of life of these patients by utilising a minimally-invasive (MI) approach. However, surgery in previously-treated patients may be challenging, and patient selection and surgical planning are crucial. Unfortunately, at the moment, validated criteria to select patients for MI-SCS are not reported, and no predictors of its feasibility are currently available, probably due to the vast heterogeneity of recurrence patterns. The aim of this narrative review is to describe the role of secondary cytoreductive surgery and, in particular, minimally-invasive procedures, in ROC, analyzing patient selection, outcomes, criticisms, and future perspectives.
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Affiliation(s)
- Camilla Certelli
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvio Andrea Russo
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Palmieri
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Aniello Foresta
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Pedone Anchora
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Virginia Vargiu
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Bruno M, Ludovisi M, Ronsini C, Capanna G, Stabile G, Guido M. Tertiary Cytoreduction for Isolated Lymphnode Recurrence (ILNR) Ovarian Cancer in a BRCA2 Mutated Patient: Our Experience and Prevalence of BRCA 1 or 2 Genes Mutational Status in ILNR. Medicina (B Aires) 2023; 59:medicina59030606. [PMID: 36984607 PMCID: PMC10056081 DOI: 10.3390/medicina59030606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 03/22/2023] Open
Abstract
We report the case of a tertiary cytoreductive surgery for isolated lymph-node recurrence (ILNR) in a 54-years old Brest cancer 2 (BRCA 2) mutated patients, with a personal history of ovarian cancer previously treated elsewhere. She was admitted to our department for a suspected isolated lymph-nodal pelvic recurrence. A positron emission tomography acquisition with contrast enhanced computed tomography (PET-CT) scan revealed an increased node at the level of the right external iliac (SUV 6.9) in correspondence with the obturator nerve, which was confirmed by transvaginal ultrasound. Since the recurrence was in a single site and the patient had previously undergone three lines of chemotherapy and maintenance with Poly(ADP-ribose) polymerase (PARP) inhibitors, we decided to perform tertiary cytoreductive surgery by minimally invasive laparoscopic approach. After gradual and careful isolation of the obturator nerve, lumbo-sacral trunk and venous vessels afferent to the external and internal iliac vein, the suspected node has been removed. No intra- and postoperative complications occurred. The patient was discharged three days after procedure. We decided to quarterly follow-up; actually, after 16 months no recurrence was detected. Several studies have reported ILNR as a unique clinical disease with low growth rate and less chemosensitivity; this can lead to considered ILNR more susceptible to take advantage of surgical treatment, even in case of second or third recurrence. The BRCA mutational status seems to play a role in the decision-making process in the approach to patients with platinum sensitive relapse of ovarian cancer or in specific isolated forms of recurrence such as the hepatic one. However, data on frequency and prognostic impact of BRCA gene mutation in ILNR are very limited. In this article we investigated the role of BRCA 1 or 2 mutational status in this rare pattern of recurrence according to more recent advances in literature.
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Affiliation(s)
- Matteo Bruno
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, 67100 L’Aquila, Italy
| | - Manuela Ludovisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giulia Capanna
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Guglielmo Stabile
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Department of Obstetrics and Gynaecology, 34137 Trieste, Italy
- Correspondence:
| | - Maurizio Guido
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Jain V, Debnath S, Sharma A, Kamboj M, Mohanty A, Rawal S. Isolated lymph node recurrence in epithelial ovarian cancer - management and outcome. J Visc Surg 2022:S1878-7886(22)00173-4. [PMID: 36564260 DOI: 10.1016/j.jviscsurg.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of our study was to assess the clinical outcome of isolated lymph node recurrence in patients with epithelial ovarian cancer treated by surgery and to analyze the impact of various clinico-pathological factors on prognosis. MATERIAL AND METHODS We conducted a retrospective analysis of all the epithelial ovarian cancer patients who underwent secondary lymphadenectomy surgery for isolated lymph node recurrence at our institute from 2013 to 2020. Univariate analysis of various factors influencing the post-recurrence disease free survival and post-recurrence survival was done using Kaplan-Meier for categorical variables and cox-proportional hazard progression for continuous variables. RESULTS A total of 21 patients of isolated lymph node recurrence were treated surgically during the study period. The median disease free interval to develop lymph nodal recurrence was 13 months. All the patients achieved complete resection to no gross residual disease without any significant morbidity associated with the procedure. The median post-recurrence disease free survival after treatment of lymph node recurrence was 25 months with 3-year post-recurrence survival of 72% and 3-year overall survival of 85%. Amongst the factors influencing post-recurrence disease free survival, young age (< 50 years), para-aortic lymph node dissection at initial surgery and single site of lymph node recurrence were significantly associated with better prognosis. A single site of lymph node recurrence was associated with significantly better post-recurrence survival. CONCLUSIONS Complete resection is feasible for epithelial ovarian cancer patients presenting with isolated lymph node recurrence, without any significant perioperative morbidity. When combined with postoperative adjuvant chemotherapy, complete resection is associated with favourable survival outcomes. Young age, para-aortic lymph node dissection during primary surgery and single site of lymph node recurrence are associated with better prognosis.
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Affiliation(s)
- V Jain
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India.
| | - S Debnath
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India
| | - A Sharma
- Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - M Kamboj
- Department of Histopathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - A Mohanty
- Department of Research, Rajiv-Gandhi Cancer Institute and Research Centre, Delhi, India
| | - S Rawal
- Department of Gynecologic Oncology, Rajiv-Gandhi Cancer Institute and research Centre, Delhi, India
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Sanna E, Madeddu C, Lavra F, Oppi S, Scartozzi M, Giorgio Calò P, Macciò A. Laparoscopic management of isolated nodal recurrence in gynecological malignancies is safe and feasible even for large metastatic nodes up to 8 cm: A prospective case series. Int J Surg 2022; 104:106744. [PMID: 35787955 DOI: 10.1016/j.ijsu.2022.106744] [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: 03/28/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The surgical treatment of isolated lymph node recurrence (ILNR) of gynecological malignancies is still debated. The feasibility and effectiveness of minimally invasive lymphadenectomy have been reported by few studies; however, it remains unclear what the upper tumor size limit is for a minimally invasive approach. We prospectively analyzed cases of ILNR treated by laparoscopy in our unit while focusing on the safety and feasibility of resecting large tumors suspected of recurrence using a minimally invasive approach. MATERIALS AND METHODS We carried out a prospective observational case-series study. We included all consecutive patients with ILNR from gynecological cancers who underwent minimally invasive lymphadenectomy at our unit from June 2013 to June 2021 to assess the safety and feasibility of such a surgical approach. We also evaluated the oncological outcome in terms of further recurrence, site of recurrence, and survival. RESULTS Twenty-seven patients with ILNR due to gynecological malignancies were included (ovarian cancer, 12; uterine malignancies, 12; cervical cancer, 3). Three had remarkably large LNs up to 8 cm: these emblematic cases have been reported in detail with accompanying videos of the surgical procedure. The most frequent site of ILNR was aortic (67%). Recurrent LNs were completely resected in all cases; none of the procedures was converted to open surgery. The median follow-up duration was 24 months. Ten patients (37%) had a new recurrence. To date five patients (18.5%) have succumbed, four (14.8%) are alive with evidence of disease, and 18 (66.7%) are alive with no evidence of disease. CONCLUSIONS Minimally invasive surgery for ILNR in gynecological malignancies may be an option feasible, safe, and effective in terms of oncological outcomes, even for large tumors. It also allows quicker recovery with early initiation of appropriate postoperative systemic chemotherapy, in the context of an optimal multimodal therapeutic approach.
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Affiliation(s)
- Elisabetta Sanna
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Clelia Madeddu
- Medical Oncology, Azienda Ospedaliero Universitaria di Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100, Cagliari, Italy.
| | - Fabrizio Lavra
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Sara Oppi
- Hematology and Transplant Center, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy.
| | - Mario Scartozzi
- Medical Oncology, Azienda Ospedaliero Universitaria di Cagliari, Department of Medical Sciences and Public Health, University of Cagliari, 09100, Cagliari, Italy.
| | - Pier Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09100, Cagliari, Italy.
| | - Antonio Macciò
- Department of Gynecologic Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09100, Cagliari, Italy; Department of Surgical Sciences, University of Cagliari, 09100, Cagliari, Italy.
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Baek MH, Park EY, Ha HI, Park SY, Lim MC, Fotopoulou C, Bristow RE. Secondary Cytoreductive Surgery in Platinum-Sensitive Recurrent Ovarian Cancer: A Meta-Analysis. J Clin Oncol 2022; 40:1659-1670. [PMID: 35188810 DOI: 10.1200/jco.21.02085] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The survival impact of secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer was studied. METHODS We identified published studies from 1983 to 2021 following our inclusion criteria from MEDLINE, EMBASE, and Cochrane library. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% CI. The publication bias was evaluated with the funnel plot and Egger's test, and sensitivity analysis was performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival (OS) time using study size as a weight. RESULTS Thirty-six studies with 2,805 patients reporting death rates were used for this meta-analysis of the 80 eligible studies. There was strong heterogeneity, with the P value of the Cochrane Q test of < 0.0001 and Higgins's I2 statistics of 86%; thus, we considered a random effect model. The pooled death rate was 44.2% (95% CI, 39.0 to 49.5), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (P < .001 and P = .005, respectively). Although 14 studies were located outside the funnel plot, Egger's test indicated no publication bias (P = .327). A sensitivity analysis excluding 14 studies showed similar results. In the linear regression model on the basis of 57 studies, the median OS time increased by 8.97% and 7.04% when the complete and optimal cytoreduction proportion increased by 10%, respectively, after adjusting other variables. CONCLUSION Secondary cytoreductive surgery, resulting in maximal tumor resection, significantly prolongs OS in platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Min-Hyun Baek
- Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Young Park
- Biostatistics Collaboration Team, Research Core Center, National Cancer Center, Goyang, South Korea.,Department of Statistics and Data Science, Yonsei University, Seoul, South Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan, South Korea
| | - Sang-Yoon Park
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer and Center for Clinical Trials, National Cancer Center, Goyang, South Korea.,Rare & Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, South Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Christina Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - Robert E Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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Jurado M, Chiva L, Tinelli G, Alcazar JL, Chi DS. The role of oncovascular surgery in gynecologic oncology surgery. Int J Gynecol Cancer 2022; 32:553-559. [PMID: 35022310 DOI: 10.1136/ijgc-2021-003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.
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Affiliation(s)
- Matias Jurado
- Department of Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Madrid, Spain
| | - Giovanni Tinelli
- Endovascular Therapies, Vascular Surgery Unit Cardiovascular Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Isolated lymph node recurrence in epithelial ovarian cancer: Recurrence with better prognosis? Eur J Obstet Gynecol Reprod Biol 2020; 249:64-69. [PMID: 32381349 DOI: 10.1016/j.ejogrb.2020.04.049] [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: 11/16/2019] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The aim of this study was to compare overall survival (OS) between women with isolated lymph node recurrence (ILNR) and those with isolated peritoneal localization of recurrence (ICR), in patients managed for epithelial ovarian cancer. METHODS Data from 1508 patients with ovarian cancer were collected retrospectively from1 January 2000 to 31 December 2016, from the FRANCOGYN database, pooling data from 11 centres specialized in ovary treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analyses were performed to define prognostic factors of overall survival. Patients included had a first recurrence defined as ILNR or ICR during their follow up. RESULTS 79 patients (5.2 %) presented with ILNR, and 247 (16.4 %) patients had isolated carcinomatosis recurrence. Complete lymphadenectomy was performed more frequently in the ILNR group vs. the ICR group (67.1 % vs. 53.4 %, p = 0.004) and the number of pelvic lymph nodes involved was higher (2.4 vs. 1.1, p = 0.008). The number of involved pelvic LN was an independent predictor of ILNR (OR = 1.231, 95 % CI [1.074-1.412], p = 0.0024). The 3-year and 5-year OS rates in the ILNR group were 85.2 % and 53.7 % respectively, compared to 68.1 % and 46.8 % in patients with ICR. There was no significant difference in terms of OS after initial diagnosis (p = 0.18). 3- year and 5-year OS rates after diagnosis of recurrence were 62.6 % and 15.6 % in the ILNR group, and 44 % and 15.7 % in patients with ICR (p = 0.21). CONCLUSION ILNR does not seem to be associated with a better prognosis in terms of OS.
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Abstract
PURPOSE OF REVIEW The aim of this review is to determine, in the light of recent evidences, the role of lymphadenectomy in ovarian cancer. RECENT FINDINGS The lymphadenectomy in ovarian neoplasms (LION) trial reports no better outcomes and higher complication and mortality rates associated with lymphadenectomy. Even if performed by expert hands, lymphadenectomy has a cost in terms of longer operative time, blood loss, higher rates of transfusions, and intensive unit care. If on the one hand retroperitoneal staging is not correlated to survival benefits both in early and advanced ovarian cancer, on the other hand it is associated with an increased surgery-related morbidity. Surgical treatment of isolated nodal recurrences seems to be feasible and associated with survival benefits.
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11
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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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Clinical and molecular characterization of ovarian carcinoma displaying isolated lymph node relapse. Am J Obstet Gynecol 2019; 221:245.e1-245.e15. [PMID: 31055034 PMCID: PMC6857430 DOI: 10.1016/j.ajog.2019.04.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/18/2019] [Accepted: 04/26/2019] [Indexed: 12/24/2022]
Abstract
Background Disease relapse is the primary cause of death from ovarian carcinoma. Isolated lymph node relapse is a rare pattern of ovarian carcinoma recurrence, with a reported median postrelapse survival of 2.5 to 4 years. To date, investigations have not compared isolated lymph node relapse ovarian carcinoma directly to a matched extranodal relapse cohort or performed molecular characterization of cases that subsequently experience isolated lymph node relapse. Objective Here we seek to compare the clinical outcome, tumor-infiltrating lymphocyte burden, and frequency of known prognostic genomic events in isolated lymph node relapse ovarian carcinoma vs extranodal relapse ovarian carcinoma. Study Design Forty-nine isolated lymph node relapse ovarian carcinoma patients were identified and matched to 49 extranodal relapse cases using the Edinburgh Ovarian Cancer Database, from which the clinical data for identified patients were retrieved. Matching criteria were disease stage, histologic subtype and grade, extent of residual disease following surgical debulking, and age at diagnosis. Clinicopathologic factors and survival data were compared between the isolated lymph node relapse and extranodal relapse cohorts. Genomic characterization of tumor material from diagnosis was performed using panel-based high-throughput sequencing and tumor-infiltrating T cell burden was assessed using immunohistochemistry for CD3+ and CD8+ cells. Results Isolated lymph node relapse cases demonstrated significantly prolonged postrelapse survival and overall survival vs extranodal relapse upon multivariable analysis (HRmulti = 0.52 [0.33–0.84] and 0.51 [0.31–0.84]). Diagnostic specimens from high-grade serous ovarian carcinomas that subsequently displayed isolated lymph node relapse harbored significantly greater CD3+ and CD8+ cell infiltration compared to extranodal relapse cases (P = .001 and P = .009, Bonferroni-adjusted P = .003 and P = .019). Isolated lymph node relapse high-grade serous ovarian carcinoma cases did not show marked enrichment or depletion of cases with BRCA1/2 mutation or CCNE1 copy number gain when compared to their extranodal relapse counterparts (24.4% vs 19.4% and 18.2% vs 22.6%, P = .865 and P = .900). Conclusion Isolated lymph node relapse ovarian carcinoma represents a distinct clinical entity with favorable outcome compared to extranodal relapse. There was no clear enrichment or depletion of BRCA1/2 mutation or CCNE1 gain in the isolated lymph node relapse ovarian carcinoma cohort compared with extranodal relapse cases, suggesting that these known prognostic genomically defined subtypes of disease do not display markedly altered propensity for isolated lymph node relapse. Diagnostic tumor material from isolated lymph node relapse patients demonstrated greater CD3+ and CD8+ cell infiltration, indicating stronger tumor engagement by T cell populations, which may contribute to the more indolent disease course of isolated lymph node relapse.
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13
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Pergialiotis V, Androutsou A, Papoutsi E, Bellos I, Thomakos N, Haidopoulos D, Rodolakis A. Survival outcomes of ovarian cancer patients treated with secondary cytoreductive surgery for isolated lymph node recurrence: A systematic review of the literature. Int J Surg 2019; 69:61-66. [PMID: 31362125 DOI: 10.1016/j.ijsu.2019.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/07/2019] [Accepted: 07/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolated lymph node recurrence (ILNR) is present in 12-37% of recurrences in ovarian cancer patients. Although several studies have investigated the impact of secondary cytoreduction in these cases, consensus still lacks concerning their optimal management. The purpose of the present review is to investigate whether secondary cytoreduction benefits patients with ILNR in terms of overall survival (OS) and post-relapse survival (PRS). METHOD The present systematic review was designed using the PRISMA and AMSTAR guidelines and has been registered with PROSPERO (CRD42019122854). We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases from inception until February 2019. RESULTS Overall, eight studies where included that recruited a total number of 479 women. Current evidence suggests that ILNR in EOC patients should be clearly distinguished from recurrences in other sites (including peritoneal and parenchymal) as their course seems to be less aggressive. Furthermore, the implementation of secondary cytoreduction as an adjunct to standard chemotherapy should be taken into consideration in this specific group of patients as the PRS may easily reach and even extend beyond 5 years. Prolonged survival (>110 months) may be seen as a realistic target for a significant number of these patients when systematic lymphadenectomy is performed. CONCLUSION The findings of our review suggest that patients with ILNR should be treated with a combined surgical and chemotherapeutic approach to optimize survival outcomes. However, further studies are needed to reach firm conclusions as current evidence is based in low quality studies.
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Affiliation(s)
- Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece.
| | - Anastasia Androutsou
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Eleni Papoutsi
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Ioannis Bellos
- Laboratory of Experimental Surgery and Surgical Research N.S Christeas, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Haidopoulos
- 1st Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Unit of Gynecologic Oncology, Alexandra Hospital, National and Kapodistrian University of Athens, Greece
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Chao WT, Chien CH, Lai CR, Wu HJ, Chuang CM. Evaluation of a Simple and Safe Tumor Drilling Technique to Potentiate the Effect of Intraperitoneal Chemotherapy in the Treatment of Recurrent Epithelial Ovarian, Tubal, and Peritoneal Cancer: A Matched Retrospective Cohort Study. Cancer Control 2019; 26:1073274819863778. [PMID: 31343898 PMCID: PMC6659185 DOI: 10.1177/1073274819863778] [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] [Indexed: 11/17/2022] Open
Abstract
Frontline intraperitoneal chemotherapy (IPCT) in the treatment of epithelial ovarian cancer has been well established. However, the role of second-line IPCT is yet to be confirmed. With a view to implementing IPCT to treat recurrent disease, a prerequisite is to perform a cytoreductive procedure to minimize residual tumor size. However, the role of cytoreductive procedure is still in debate due to a higher chance of complications. A matched retrospective cohort study was conducted. From 2008 to 2015, we adopted a relatively simple and safe tumor drilling technique to maximize tumor exposure to second-line IPCT. Patients who received tumor drilling followed by second-line IPCT constituted the cohort group. Concurrently, patients who received standard second-line systemic chemotherapy were selected as the comparison group. After propensity score matching, 85 patients in each group entered into the final analysis. The median progression-free survival was 7.3 months (95% confidence interval [CI], 6.2-7.8) for the cohort group versus 4.1 months (95% CI, 4.0-4.3) for the comparison group (hazard ratio = 0.25 [95% CI, 0.17-0.36]; P < .001, by log-rank test). The median overall survival was 33.6 months (32.1-36.6) for the cohort group versus 25.9 months (20.5-26.9) for the comparison group (hazard ratio = 0.33 [95% CI, 0.23-0.48]; P < .001, by log-rank test). Toxicities in the cohort group were not different from those that were published in reports of IPCT for ovarian cancer. The most commonly observed toxicity was gastrointestinal origin (51.7%), and it may be attributed to the intraperitoneal pharmacokinetic clearance of cisplatin and taxol and we also discussed the mechanism of gastrointestinal toxicity. Tumor drilling followed by second-line IPCT may confer a survival advantage over standard second-line systemic chemotherapy in the treatment of recurrent ovarian cancer.
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Affiliation(s)
- Wei-Ting Chao
- 1 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei.,2 Institute of Clinical Medicine, National Yang-Ming University, Taipei.,3 Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei
| | - Ching-Hui Chien
- 4 College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City
| | - Chung-Ru Lai
- 1 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei.,2 Institute of Clinical Medicine, National Yang-Ming University, Taipei.,5 Department of Pathology, Taipei Veterans General Hospital, Taipei City
| | - Hui-Ju Wu
- 3 Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei
| | - Chi-Mu Chuang
- 1 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei.,2 Institute of Clinical Medicine, National Yang-Ming University, Taipei.,3 Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei.,4 College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City.,6 Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei City
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15
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Song YJ, Suh DS, Kim KH, Na YJ, Lim MC, Park SY. Suprarenal lymph node dissection by the Kocher maneuver in the surgical management of ovarian cancer. Int J Gynecol Cancer 2019; 29:647-648. [PMID: 30733277 DOI: 10.1136/ijgc-2018-000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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16
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Bogani G, Leone Roberti Maggiore U, Chiappa V, Ditto A, Martinelli F, Sabatucci I, Mosca L, Lorusso D, Raspagliesi F. The addition of lymphadenectomy to secondary cytoreductive surgery in comparison with bulky node resection in patients with recurrent ovarian cancer. Int J Gynaecol Obstet 2018; 143:319-324. [DOI: 10.1002/ijgo.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/07/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Umberto Leone Roberti Maggiore
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
- Obstetrics and Gynecology; IRCCS AOU San Martino; Italy/Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI); University of Genoa; Genoa Italy
| | | | - Antonino Ditto
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Fabio Martinelli
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Ilaria Sabatucci
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Lavinia Mosca
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
| | - Domenica Lorusso
- Gynecologic Oncology; IRCCS National Cancer Institute; Milan Italy
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Giri S, Shah SH, Batra K, Anu-Bajracharya, Jain V, Shukla H, Sekhon R, Rawal S. Presentation and Management of Inguinal Lymphadenopathy in Ovarian Cancer. Indian J Surg Oncol 2016; 7:436-440. [PMID: 27872532 DOI: 10.1007/s13193-016-0556-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022] Open
Abstract
The symptoms in ovarian cancer are often missed leading to dubious diagnosis and staging. Inguinal lymphadenopathy (ILAP) is reported to be rare and occurring via lymphatic or hematogenous route. The paucity of studies on ILAP in ovarian cancer indicates a scope of refining its staging and management. The present study aims to document the presentation and management of ILAP in ovarian cancer, which may also reflect its incidence and mechanism of spread. All patients of ovarian cancer with inguinal lymphadenopathy presenting to our institute from 1 January 2015 to 31 December 2015 were included. All clinical, treatment, and pathological details were analyzed. Seven patients of ovarian cancer presented with ILAP. The mean age and BMI were 53.29 +/- 8.38 years and 26.23 +/- 3.03 kg/m2. Presentation varied from advanced disease (adnexal, omental, peritoneal, and nodal) to isolated ILAP even without adnexal mass (n = 4). Mean CA 125 was 229.64 +/- 322 (20-924) and ovarian primary was confirmed on microscopy or immunohistochemistry. Six patients underwent surgery with (n = 4) or without neoadjuvant chemotherapy (n = 2). Complete cytoreduction could be achieved in all patients with acceptable operative and perioperative outcomes. Peritoneal surface spread, along hernia track to the groin, was seen in two patients. Histopathology showed advanced disease, isolated ILAP and no residual disease in 3, 2, and 1 patient, respectively. ILAP has diverse clinical presentation in ovarian cancers and is not that uncommon. ILAP may also occur by peritoneal surface spread and shows good results with cytoreductive surgery and chemotherapy.
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Affiliation(s)
- Shveta Giri
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Swati H Shah
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Kanika Batra
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Anu-Bajracharya
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Vandana Jain
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Himanshu Shukla
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Rupinder Sekhon
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
| | - Sudhir Rawal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi 110085 India
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Bhatt A, Glehen O. The role of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer: A Review. Indian J Surg Oncol 2016; 7:188-97. [PMID: 27065709 DOI: 10.1007/s13193-016-0501-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/28/2016] [Indexed: 02/07/2023] Open
Abstract
Ovarian cancer is one of the leading causes of cancer related deaths in women worldwide. It is usually diagnosed in an advanced stage (Stages III and IV) when peritoneal cancer spread has already occurred. The standard treatment comprises of surgery to remove all macroscopic disease followed by systemic chemotherapy. Despite all efforts, it recurs in over 75 % of the cases, most of these recurrences being confined to the peritoneal cavity. Recurrent ovarian cancer has a poor long term outcome and is generally treated with multiple lines of systemic chemotherapy and targeted therapy. The propensity of ovarian cancer to remain confined to the peritoneal cavity warrants an aggressive locoregional approach. The combined treatment comprising of cytoreductive surgery (CRS) that removes all macroscopic disease and HIPEC (Hyperthermic Intraperitoneal Chemotherapy) has been effective in providing long term survival in selected patients with peritoneal metastases of gastrointestinal origin. Intraperitoneal chemotherapy used as adjuvant therapy has shown a survival benefit in ovarian cancer. This has prompted the use of CRS and HIPEC in the management of ovarian cancer as a part of first line therapy and second line therapy for recurrent disease. This article reviews the current literature and evidence for the use of HIPEC in ovarian cancer.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Fortis Hospital, Bangalore, India
| | - Olivier Glehen
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, 69495 Pierre-Bénite, Cedex France ; Université Lyon 1, EMR 3738, 69600 Oullins, France
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Bhat RA, Chia YN, Lim YK, Yam KL, Lim C, Teo M. Survival Impact of Secondary Cytoreductive Surgery for Recurrent Ovarian Cancer in an Asian Population. Oman Med J 2015; 30:344-52. [PMID: 26421115 DOI: 10.5001/omj.2015.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the role of secondary cytoreductive surgery in Asian patients with recurrent ovarian cancer and to assess prognostic variables on overall post-recurrence survival time. METHODS We conducted a retrospective review of patients with recurrent ovarian cancer who underwent secondary cytoreduction at the Gynaecological Cancer Center at the KK Women's and Children's Hospital, Singapore, between 1999 and 2009. Eligible patients included those who had been firstly treated by primary cytoreductive surgery and followed by adjuvant chemotherapy and had a period of clinical remission of at least six months and subsequently underwent secondary cytoreductive surgery for recurrence. Univariate analysis was performed to evaluate various variables influencing the overall survival. RESULTS Twenty-five patients met our eligibility criteria. The median age was 52 years (range=31-78 years). The median time from completion of primary treatment to recurrence was 25.1 months (range=6.4-83.4). Secondary cytoreduction was optimal in 20 of 25 patients (80%). The median follow-up duration was 38.9 months (range=17.8-72.4) and median overall survival time was 33.1 months (95% confidence interval, 15.3-undefined.). Ten (40.0%) patients required bowel resection, but no end colostomy was performed. One (4.0%) patient had wedge resection of the liver, one (4.0%) had a distal pancreatectomy, one (4.0%) had a unilateral nephrectomy, and one (4.0%) had adrenalectomy. There were no operative deaths. The overall survival of patients who responded to secondary cytoreductive surgery and adjuvant chemotherapy was significantly longer than those patients who did not respond to the treatment. Of those patients who responded to the surgical management, patients with clear cell carcinoma fared well compared to those with the endometrioid, mucinous adenocarcinoma, and papillary serous type (p<0.001). Complete secondary cytoreductive surgery appeared to have some relationship to overall survival but was not statistically significant. CONCLUSION In carefully selected patients with recurrent ovarian cancer, optimal cytoreductive surgery is possible and in a subgroup of patients who respond to surgery and chemotherapy survival is significantly longer.
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Affiliation(s)
- Rani Akhil Bhat
- Department of Gynaecologic Oncology, BGS Global Hospitals, Bangalore, India
| | - Yin Nin Chia
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Yong Kuei Lim
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Kwai Lam Yam
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | - Cindy Lim
- Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore
| | - Melissa Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
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Kato K, Usami T, Takeshima N. Secondary debulking surgery for isolated para-aortic nodal recurrence in ovarian cancer involving the division of the left renal vein. Gynecol Oncol 2015; 137:188-9. [PMID: 25680865 DOI: 10.1016/j.ygyno.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/03/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present a case that involved para-aortic lymphadenectomy in the aortocaval and retrocaval region involving the division of the left renal vein (LRV). METHODS A 36-year-old woman presented with ovarian cancer and isolated nodal recurrence located in the aortocaval and retrocaval region above and below the renal vein. Cytoreduction of para-aortic lymph nodes involving the division of the LRV was performed. RESULTS AND CONCLUSION Division of the LRV facilitates the separation of the lymph nodes from the renal artery or inferior vena cava under direct vision. No intra- or early postoperative complications, including renal dysfunction, occurred. Further analyses with long-term follow-up are warranted to evaluate this surgical method.
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Affiliation(s)
- Kazuyoshi Kato
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
| | - Tomoka Usami
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan
| | - Nobuhiro Takeshima
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan
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21
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Escobar PF, Levinson KL, Magrina J, Martino MA, Barakat RR, Fader AN, Leitao MM. Feasibility and perioperative outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer: A multi-institutional study. Gynecol Oncol 2014; 134:253-6. [DOI: 10.1016/j.ygyno.2014.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 01/10/2023]
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22
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Ferrero A, Ditto A, Giorda G, Gadducci A, Greggi S, Daniele A, Fuso L, Panuccio E, Scaffa C, Raspagliesi F, Sismondi P, Biglia N. Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: A multicenter study. Eur J Surg Oncol 2014; 40:891-8. [DOI: 10.1016/j.ejso.2013.11.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/25/2013] [Accepted: 11/29/2013] [Indexed: 11/17/2022] Open
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Chen CW, Torng PL, Chen CL, Chen CA. Clinical features and outcomes of neck lymphatic metastasis in ovarian epithelial carcinoma. World J Surg Oncol 2013; 11:255. [PMID: 24088247 PMCID: PMC3850746 DOI: 10.1186/1477-7819-11-255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 09/22/2013] [Indexed: 11/25/2022] Open
Abstract
Background Neck lymph node metastasis (NLNM) in epithelial ovarian cancer (EOC) is rare and treated as advanced stage cancer. However, ovarian cancer with lymphatic metastasis may manifest a different clinical course from peritoneal carcinomatosis. Methods The authors retrospectively assessed 20 patients with EOC and pathologically diagnosed as NLNM between January 2001 and December 2010. The patients were divided into two groups according to the time of NLNM identification. Statistical methods included Kaplan-Meier, log-rank, and Cox regression analysis. Results Eleven patients were diagnosed with NLNM at the same time of surgical exploration of EOC (Group A) and nine patients at cancer recurrence 43.3 months after initial surgery (Group B). In Group A, patients with tumors confined to the pelvic cavity had no recurrence or had isolated lymph node recurrence (ILNR), and survived longer than patients with abdominal tumor spreading (P = 0.0007). In Group B, 2 patients showed ILNR. The median survival time after NLNM was 42 months in Group A and 6 months in Group B (P = 0.01). Cox model demonstrated that non-serous histology, brain metastasis, and NLNM identified at cancer recurrence were major predictors for poor overall survival (Hazard ratio [HR] = 18.67, 6.93, and 4.52; P = 0.01, 0.02, and 0.04, respectively). Conclusions A subgroup of EOC patients with NLNM who presented limited pelvic cancer had much better overall survival than patients who had cancer spreading beyond the pelvic cavity or were diagnosed with NLNM at cancer recurrence.
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Affiliation(s)
- Chien-Wen Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, No, 7, Chung Shan South Road, Taipei 10002, Taiwan.
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Kato K, Omatsu K, Takeshima N. Secondary debulking surgery in ovarian cancer patients with isolated nodal recurrence located in the region above and behind the renal vein. Gynecol Oncol 2013; 130:226-8. [PMID: 23562521 DOI: 10.1016/j.ygyno.2013.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 03/05/2013] [Accepted: 03/26/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We describe our early experience with a suprarenal and retrorenal para-aortic lymphadenectomy involving the mobilization of the left kidney. METHODS Three patients with isolated nodal recurrence located in the region above and behind the renal vein underwent the removal of these metastatic lymph nodes using a left renal mobilization procedure. RESULTS AND CONCLUSION The enlarged suprarenal and retrorenal lymph nodes were safely and effectively removed in all 3 patients. Postoperatively, a lymphatic fistula developed in one patient. However, no morbidities related to renal mobilization, including renal ischemia, were observed in the current series. A further large, prospective study is required to evaluate this surgical procedure.
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Affiliation(s)
- Kazuyoshi Kato
- Department of Gynecology, Cancer Institute Hospital, 3-8-31 Ariake, Koutou-ku, Tokyo 135-8550, Japan.
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Tanaka T, Ohmichi M. Recurrent ovarian cancer presenting in the right supraclavicular lymph node with isolated metastasis: a case report. J Med Case Rep 2012; 6:176. [PMID: 22747642 PMCID: PMC3460739 DOI: 10.1186/1752-1947-6-176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction The majority of ovarian cancer recurrences are in the abdomen. However, some cases relapse as isolated lymph node metastases, mostly in pelvic or para-aortic nodes. Peripheral isolated lymph node metastasis is rare. Case presentation A 69-year-old Japanese woman had recurrent ovarian cancer presenting with isolated right supraclavicular lymph node metastasis. After surgical resection and combination chemotherapy with carboplatin and paclitaxel, her right supraclavicular lymph node completely regressed. Conclusions Peripheral isolated lymph nodes, including right supraclavicular lymph node, can recur without a macroscopic abdominal lesion. Clinicians should carefully examine peripheral lymph nodes for recurrence.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Minami Medical Center, 2-1, Kidohigashi-machi, Kawachinagano, Osaka, 586-8521, Japan.
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Boran N, Hizli D, Yilmaz S, Turan T, Celik B, Karabuk E, Isikdogan Z, Tulunay G, Kose MF. Secondary cytoreductive surgery outcomes of selected patients with paclitaxel/platinum sensitive recurrent epithelial ovarian cancer. J Surg Oncol 2012; 106:369-75. [DOI: 10.1002/jso.23094] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/16/2012] [Indexed: 11/09/2022]
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Laparoscopic Lymphadenectomy for Isolated Lymph Node Recurrence in Gynecologic Malignancies. J Minim Invasive Gynecol 2012; 19:188-95. [DOI: 10.1016/j.jmig.2011.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 10/22/2011] [Accepted: 10/27/2011] [Indexed: 10/14/2022]
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Schorge JO, Eisenhauer EE, Chi DS. Current surgical management of ovarian cancer. Hematol Oncol Clin North Am 2011; 26:93-109. [PMID: 22244664 DOI: 10.1016/j.hoc.2011.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical management of ovarian cancer requires excellent judgment and mastery of a wide array of procedures. Involvement of a gynecologic oncologist improves outcomes. Staging of apparent stage I disease is important. Minimally invasive techniques provide advantages. Primary debulking surgery provides the best long-term survival of any strategy in advanced ovarian cancer. Aggressive surgical paradigms have the greatest success. Further cytoreductive surgery may be appropriate. Most relapsed patients require management of bowel obstruction at some point. Palliative intervention can enhance quality of life. Surgical correction may extend survival. For end-stage patients with progressive disease, the treating gynecologic oncologist must manage expectations.
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Affiliation(s)
- John O Schorge
- Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
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Comparison of the Efficacy and Toxicity Between Radiotherapy and Chemotherapy in Nodal and Isolated Nonnodal Recurrence of Ovarian Cancer. Int J Gynecol Cancer 2011; 21:1032-9. [DOI: 10.1097/igc.0b013e31821e0353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bhosale P, Peungjesada S, Wei W, Levenback CF, Schmeler K, Rohren E, Macapinlac HA, Iyer RB. Clinical utility of positron emission tomography/computed tomography in the evaluation of suspected recurrent ovarian cancer in the setting of normal CA-125 levels. Int J Gynecol Cancer 2010; 20:936-44. [PMID: 20683399 DOI: 10.1111/igc.0b013e3181e82a7f] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES This study was conducted to estimate the accuracy of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as compared with contrast-enhanced CT (CECT) in detecting cancer in patients who have normal cancer antigen (CA)-125 (<35 U/dL) but are suspected of having a recurrent disease based on clinical symptoms. METHODS We retrospectively reviewed the records of patients who had undergone primary cytoreductive surgery and subsequently underwent CECT and FDG-PET/CT for suspected recurrence. [18F]-fluorodeoxyglucose positron emission tomography/computed tomography and CECT interpretation to evaluate a recurrent disease was carried out independently by 2 experienced radiologists who were blinded to the final diagnosis for the suspected recurrence. Long-term follow-up imaging (12 months) and biopsy reports were used to assess the true status of the suspected recurrence seen on FDG-PET/CT or CECT. Sensitivity and specificity of all modalities were estimated. McNemar test was used to compare pairs of modalities. All tests were 2-sided, and P < or = 0.05 was considered statistically significant. RESULTS Sixty-six patients met the eligibility criteria for inclusion in our analysis. Fifty-eight percent (18/31) and 54% (17/31) of the patients with normal CA-125 levels had evidence of a recurrent disease on FDG-PET/CT and CECT, respectively. Thirty-one percent (6/19) of the patients with no indication of cancer on CECT had evidence of disease on FDG-PET/CT images, which was supported by pathological proof. CONCLUSION [18F]-Fluorodeoxyglucose positron emission tomography/computed tomography is capable of detecting ovarian cancer recurrence in symptomatic patients with normal CA-125 levels and, in this setting, has slightly better sensitivity than CECT and can be considered as the frontline modality for all such patients.
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Affiliation(s)
- Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Fotopoulou C, Richter R, Braicu IE, Schmidt SC, Neuhaus P, Lichtenegger W, Sehouli J. Clinical outcome of tertiary surgical cytoreduction in patients with recurrent epithelial ovarian cancer. Ann Surg Oncol 2010; 18:49-57. [PMID: 20697821 DOI: 10.1245/s10434-010-1245-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Indexed: 01/23/2023]
Abstract
BACKGROUND The value of tertiary cytoreductive surgery (TCS) on overall survival (OS) of patients with relapsed epithelial ovarian cancer (ROC) is not well defined. Aim of the present study was to evaluate the operative and clinical outcome after TCS. METHODS We systematically evaluated all consecutive patients undergoing TCS. Tumor dissemination pattern, operative morbidity, residual tumor, and survival are described based on a validated intraoperative documentation tool. Predictors of survival and complete tumor resection are analyzed with Cox regression or logistic regression models. RESULTS Between October 2000 and December 2008, 135 patients (median age, 51 years; range, 22-80 years) of mainly initial FIGO stage ≥ III (106 patients, 78.5%) were evaluated. In 53 patients (39.3%) a complete tumor-resection was obtained. The 1-month operative mortality was 6%. During a median follow-up period of 9.6 months (range, 0.1-75 months), 78 patients (57.8%) died, while 52 patients (38.5%) experienced a further relapse. Median OS was 19.1 months for the total collective (95% confidence interval [95% CI], 14.84-23.35). Median OS was 37.8 months (95% CI, 12.7-62.7) for patients without residual tumor; versus 19.0 months (95% CI, 9.8-28.2) for residual tumor ≤ 1 cm and 6.9 months (95% CI, 3.05-10.7) for residual tumor > 1 cm (P < .001). The presence of peritoneal carcinomatosis did not seem to significantly affect OS. Complete tumor resection was identified as the strongest predictor of OS. Other independent predictors of OS were interval to primary diagnosis ≥ 3 years (hazard ratio [HR], 0.28; 95% CI, 0.14-0.59) and serous papillary histology (HR, 0.23; 95% CI, 0.09-0.56). A total of 42 patients (31.1%) presented at least 1 major complication. Multivariate analysis identified tumor involvement of the middle abdomen and peritoneal carcinomatosis as independent predictors of complete tumor resection. CONCLUSIONS Postoperative tumor residual disease remains the strongest predictor of survival even in TCS setting. To identify the optimal candidates for TCS, the predictive value of ascites and peritoneal carcinomatosis should be confirmed by future prospective trials.
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Affiliation(s)
- Christina Fotopoulou
- Department of Gynecology, Charité University Medical Center Berlin, Berlin, Germany.
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Imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease in patients with gynecologic malignancies: clinical experience with eight patients. AJR Am J Roentgenol 2010; 194:1635-8. [PMID: 20489107 DOI: 10.2214/ajr.09.3561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of imaging-guided percutaneous radiofrequency ablation to treat metastatic retroperitoneal disease in patients with gynecologic malignancies. MATERIALS AND METHODS Patients with retroperitoneal metastatic disease due to gynecologic malignancies were evaluated for imaging-guided percutaneous radiofrequency ablation in this study. Efficacy of treatment was assessed by post-radiofrequency ablation activity on PET/CT scans. RESULTS Eight patients were considered for imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease. Radiofrequency ablation was successfully completed in five patients with six metastatic tumors. All procedures were performed with the use of hydrodissection as an adjunct maneuver to displace adjacent structures. All patients showed absence of FDG activity on post-radiofrequency ablation PET/CT scans. Three (60%) of the five patients showed absence of FDG activity of the treated disease at 23.5 months after radiofrequency ablation. CONCLUSION Imaging-guided percutaneous radiofrequency ablation may be considered as an alternative to currently available therapies to treat recurrent metastatic disease due to endometrial carcinoma.
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Secondary cytoreductive surgery for recurrent platinum-sensitive ovarian cancer. Int J Gynaecol Obstet 2009; 108:123-7. [DOI: 10.1016/j.ijgo.2009.08.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/12/2009] [Accepted: 09/23/2009] [Indexed: 01/23/2023]
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