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Sinukumar S, Ray M, Damodaran D, Katdare N, Vikram S, Shaikh S, Patel A, Bhatt A. A Descriptive Analysis of Patients Undergoing Cytoreductive Surgery for the First Peritoneal Recurrence from Adult Granulosa Cell Tumours: Focus on Disease Distribution, Morphology of Peritoneal Disease and the Role of HIPEC - a Retrospective Study by INDEPSO. Indian J Surg Oncol 2023; 14:82-91. [PMID: 37359921 PMCID: PMC10284733 DOI: 10.1007/s13193-022-01651-2] [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: 06/16/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022] Open
Abstract
The aim of the present study was to report the clinical outcome and factors affecting survival in patients with first recurrence of AGC treated with cytoreductive surgery with or without HIPEC. The second aim was to study the disease distribution in the peritoneal cavity according to the peritoneal carcinomatosis index (PCI) and the morphology of peritoneal deposits. In this retrospective multicentric study, all patients of adult granulosa cell tumor with peritoneal recurrence were treated with CRS with or without HIPEC. Relevant clinical and demographic data were captured. Multivariable logistic regression was performed to evaluate the factors affecting recurrence after CRS ± HIPEC. Factors affecting survival and second recurrences were evaluated in addition to studying the disease distribution at first recurrence. In the period from January 2013 to December 2021, 30 consecutive patients of recurrent adult type granulosa cell tumor of the ovary undergoing CRS ± HIPEC were included in this study. The median follow-up duration was 55 months [12-96 months]. The median rPFS and rOS were both not reached. HIPEC (p = 0.015) was the only factor independently associated with a longer rPFS. CRS with or without HIPEC can be performed with an acceptable morbidity in patients with the first recurrence from adult granulosa cell tumours. The role of HIPEC, patterns of peritoneal spread and impact of other prognostic factors on the treatment outcome all need further evaluation in larger series of patients.
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra India
| | - Mukurdipi Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, Delhi India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR, Cancer Center and Research Institute, Calicut, Kerela India
| | - Ninad Katdare
- Department of Surgical Oncology, HCG Cancer Center, Mumbai, Maharashtra India
| | - Syam Vikram
- Department of Surgical Oncology, MVR, Cancer Center and Research Institute, Calicut, Kerela India
| | - Sakina Shaikh
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
| | - Ankita Patel
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
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Sinukumar S, Damodaran D, Ray M, Prabhu A, Katdare N, Vikram S, Shaikh S, Patel A, Bhatt A. Cytoreductive Surgery With or Without HIPEC in the Management of Peritoneal Dissemination from Rare Histological Subtypes of Ovarian Cancer - a Retrospective Study by INDEPSO. Indian J Surg Oncol 2023; 14:74-81. [PMID: 37359936 PMCID: PMC10284742 DOI: 10.1007/s13193-022-01640-5] [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: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022] Open
Abstract
The aim of this study was to evaluate the potential role of optimal cytoreductive surgery with or without HIPEC in the management of peritoneal dissemination from rare histological subtypes of ovarian cancer and to report the prognostic factors affecting survival. In this retrospective multicentric study, all patients with diagnosis of locally advanced ca ovary with histology other than high-grade serous carcinoma and those having undergone cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy for the same were included. Factors affecting survival were evaluated in addition to studying the clinicopathological features. In the period from January 2013 to December 2021, 101 consecutive patients of ovarian cancer with rare histology underwent cytoreductive surgery with or without HIPEC. The median OS was not reached (NR), and the median PFS was 60 months. On evaluation of factors affecting overall survival (OS) and progression-free survival (PFS), PCI > 15 was associated with not only a decreased PFS (p = 0.019) but also a decreased OS (P = 0.019) on univariate and multivariate analysis. With respect to histology, the best OS and PFS were seen with granulosa cell tumor, mucinous tumors for which median OS and median PFS were NR respectively. Cytoreductive surgery can be performed with an acceptable morbidity in patients with peritoneal dissemination from ovarian tumors of rare histology. The role of HIPEC and impact of other prognostic factors on the treatment and survival outcome need further evaluation in larger series of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-022-01640-5.
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Affiliation(s)
- Snita Sinukumar
- Department of Surgical Oncology, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra India
- Department of Surgical Oncology, MVR, Cancer Center and Research Institute, Calicut, Kerala India
| | - Dileep Damodaran
- Department of Surgical Oncology, MVR, Cancer Center and Research Institute, Calicut, Kerala India
| | - Mukurdipi Ray
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, Delhi India
| | - Aruna Prabhu
- Department of Surgical Oncology, Thangam Cancer Centre, Namakkal, Tamil Nadu India
| | - Ninad Katdare
- Department of Surgical Oncology, HCG Cancer Center, Mumbai, Maharashtra India
| | - Syam Vikram
- Department of Surgical Oncology, MVR, Cancer Center and Research Institute, Calicut, Kerala India
| | - Sakina Shaikh
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
| | - Ankita Patel
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
| | - Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India
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Plett H, Ricciardi E, Vacaru V, Ramspott JP, Colombo N, Sehouli J, du Bois A, Garbi A, Richter R, Ataseven B, Aletti G, Braicu E, Heitz F, Portuesi R, Muallem MZ, Dagres T, Parma G, Roser E, Traut A, Multinu F, Harter P. Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence. Int J Gynecol Cancer 2023; 33:734-740. [PMID: 36759002 DOI: 10.1136/ijgc-2022-003854] [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: 02/11/2023] Open
Abstract
OBJECTIVE Adult granulosa cell tumors represent less than 5% of all ovarian malignancies. The aim of this study was to analyze the clinicopathological parameters and their impact on progression-free and overall survival. METHODS Patients with primary adult granulosa cell tumors treated in three international referral centers between July 1999 and December 2018 were included. The following data were anonymously exported from the prospective database: age at diagnosis, International Federation of Gynecology and Obstetrics (FIGO) stage, adjuvant therapy, surgical procedures, progression-free survival, and overall survival. Descriptive statistical analysis regarding tumor and treatment characteristics was performed. Survival analyses included Kaplan-Meier functions and Cox proportional hazard ratios (HR). RESULTS A total of 168 patients with primary adult granulosa cell tumors were included. Median age was 50 years (range 13-82). With regard to stage distribution, 54.2% (n=91) of patients were FIGO stage IA, 1.2% (n=2) were stage IB, 26.8% (n=45) were stage IC, and 17.9% (n=30) were FIGO stage II-IV. 66.7% (n=112) of patients underwent surgical restaging, of whom 17.9% (n=20) were moved to a higher stage. In addition, 36 (21.4%) patients underwent fertility-sparing surgery. After a median follow-up of 61 months (range 0-209), 10.7% of patients (n=18) had recurrent disease and 4.8% (n=8) died of disease. Five-year progression-free survival was 86.1% and estimated overall survival was 95.7%. Five-year progression-free survival was worse for patients with advanced stages (FIGO stage IA/B vs IC: HR 5.09 (95% CI 1.53 to 16.9); FIGO stage IA/B vs II-IV: HR 5.62 (95% CI 1.58 to 19.9)). Nineteen patients receiving adjuvant chemotherapy had lower estimated 5-year progression-free survival compared with patients not receiving chemotherapy (49.7% vs 91.1%, p<0.001; HR 9.15 (95% CI 3.62 to 23.1)). CONCLUSION The prognosis of patients with primary adult granulosa cell tumors is mainly determined by FIGO stage. The outcome of patients with FIGO stage IC is comparable to those with advanced stages. Fertility-sparing surgery seems to be a safe procedure in stage IA. Our data do not support the use of adjuvant chemotherapy in early and advanced stages of adult granulosa cell tumors.
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Affiliation(s)
- Helmut Plett
- Department of Gynecology, University Hospital Leipzig, Leipzig, Germany .,Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Enzo Ricciardi
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Ospedale Sandro Pertini, Rome, Italy.,Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Vlad Vacaru
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Division of Gynecology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Jan Philipp Ramspott
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Nicoletta Colombo
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Faculty of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Andreas du Bois
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Annalisa Garbi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Rolf Richter
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Beyhan Ataseven
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Giovanni Aletti
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Elena Braicu
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Rosalba Portuesi
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.,IRCCS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mustafa-Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany.,Berlin Institute of Health, Berlin, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Timoleon Dagres
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Gabriella Parma
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Eva Roser
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin, Berlin, Germany
| | - Alexander Traut
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
| | - Francesco Multinu
- Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Philipp Harter
- Department of Gynecology and Gynecologic Oncology, Ev. Kliniken Essen-Mitte, Essen, Germany
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Yasukawa M, Matsuo K, Matsuzaki S, Dainty LA, Sugarbaker PH. Management of recurrent granulosa cell tumor of the ovary: Contemporary literature review and a proposal of hyperthermic intraperitoneal chemotherapy as novel therapeutic option. J Obstet Gynaecol Res 2020; 47:44-51. [PMID: 33103312 DOI: 10.1111/jog.14494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/25/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
Granulosa cell tumors of the ovary (GCT) are the most common type of sex cord stromal tumors. Although most of patients are diagnosed at early stage and has favorable 5-year overall survival rate, 16-23% of GCT ultimately develop recurrent disease. Recurrences are characterized by disseminated peritoneal metastasis. The treatment options include systemic chemotherapy, secondary CRS or palliative localized radiation therapy have not yet standardized due to the rarity of disease. Aggressive CRS followed up by hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to provide benefit in other peritoneal disease but limited data available for recurrent GCT. We have a case of recurrent Adult-type GCT (AGCT) who was treated with CRS followed by HIPEC with mitomycin C and doxorubicin. The patient has no evidence of recurrence for approximately 11 years. An electronic search of the PubMed database with the following search terms: GCT, HIPEC showed that there were total 21 patients with recurrent GCT treated in seven different studies and 13 of 21 (61.9%) patients had no evidence of disease during follow-up ranging from 6 to 100 months. Three patients (14.2%) died of the disease. Six studies used cisplatin for HIPEC. At least 76.2% (16 of 21, data not available for five patients) had complete cytoreduction with total 16 cases of perioperative complications but no perioperative mortality was observed. Although further investigation is needed, we propose that CRS and HIPEC can be an effective therapeutic option for recurrent GCT at experienced institutions.
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Affiliation(s)
- Maya Yasukawa
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Koji Matsuo
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Shinya Matsuzaki
- Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Louis A Dainty
- Regional Director of Gynecologic Oncology at Georgetown Lombardi Comprehensive Cancer Center, Chief of Gynecologic Oncology Department at MedStar Washington Cancer, Washington, District of Columbia, USA
| | - Paul H Sugarbaker
- Chief of Peritoneal Surface Malignancy Program and Director of the Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, District of Columbia, USA
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