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Praiss AM, Zhou Q, Iasonos A, Moukarzel L, Dessources K, Soldan K, Su K, Sonoda Y, Roche KL, Gardner GJ, Troso-Sandoval T, Tew WP, Grisham RN, Chi DS, O'Cearbhaill RE, Zivanovic O. Morbidity after secondary cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy for ovarian cancer: An analysis of a randomized phase II trial. Gynecol Oncol 2023; 171:23-30. [PMID: 36804618 PMCID: PMC10206782 DOI: 10.1016/j.ygyno.2023.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To assess postoperative complications after secondary cytoreductive surgery (SCS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC), we conducted an exploratory analysis of patients with platinum-sensitive recurrent ovarian cancer enrolled in a randomized phase II trial. METHODS Complications occurring within 30 days of surgery were graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0; only hemoglobin and platelet levels were assessed. Patients were grouped by CTCAE grade ≥ 3 and < 3 complications. RESULTS Among 83 eligible patients, 33 (40%) had grade ≥ 3 complications and 50 (60%) had grade < 3 complications; anemia and abdominal infections were the most common. There were no perioperative mortalities. Time to initiation of postoperative chemotherapy for patients with grade ≥ 3 and grade < 3 events was 34 days (range, 18-60) and 31 days (range, 21-43), respectively (P = .017). Median progression-free survival (PFS) did not significantly differ between patients with grade ≥ 3 and grade < 3 complications (11.2 months [95% CI: 9.3-14.4] vs 14.9 months [95% CI: 11.3-16.5], respectively; P = .186), nor did median overall survival (OS) (46.9 months [95% CI: 34-NE] vs 68.2 months [95% CI: 52.1-NE], respectively; P = .053). CONCLUSION Postoperative complications following SCS with or without HIPEC were associated with slight delays in chemotherapy initiation but did not significantly impact oncologic outcomes.
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Affiliation(s)
- Aaron M Praiss
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Qin Zhou
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alexia Iasonos
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lea Moukarzel
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Kimberly Dessources
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Krysten Soldan
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Katy Su
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Tiffany Troso-Sandoval
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - William P Tew
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Rachel N Grisham
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States.
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Potential Prognostic Role of 18F-FDG PET/CT in Invasive Epithelial Ovarian Cancer Relapse. A Preliminary Study. Cancers (Basel) 2019; 11:cancers11050713. [PMID: 31126127 PMCID: PMC6562912 DOI: 10.3390/cancers11050713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of advanced cases with poor prognosis. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT (18F-FDGPET/CT) is the most specific radiological imaging used to assess recurrence. Some intensity-based and volume-based PET parameters, maximum standardized uptake values (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), are indicated to have a correlation with treatment response. The aim of our study is to correlate these parameters with post relapse survival (PRS) and overall survival (OS) in Epithelial Ovarian Cancer (EOC) relapse. The study included 50 patients affected by EOC relapse who underwent 18F-FDGPET/CT before surgery. All imaging was reviewed and SUVmax, MTV and TLG were calculated and correlated to PRS and OS. PRS and OS were obtained from the first relapse and from the first diagnosis to the last follow up or death, respectively. SUVmax, MTV and TLG were tested in a univariate logistic regression analysis, only SUVmax demonstrated to be significantly associated to PRS and OS (p = 0.005 and p = 0.024 respectively). Multivariate analysis confirmed the results. We found a cut-off of SUVmax of 13 that defined worse or better survival (p = 0.003). In the first relapse of EOC, SUVmax is correlated to PRS and OS, and when SUVmax is greater than 13, it is an unfavorable prognostic factor.
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Baumann KH, Wagner U, du Bois A. The changing landscape of therapeutic strategies for recurrent ovarian cancer. Future Oncol 2013; 8:1135-47. [PMID: 23030488 DOI: 10.2217/fon.12.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Advanced epithelial ovarian cancer, cancer of the fallopian tube and primary peritoneal cancer have a poor prognosis and a high rate of disease recurrence following primary therapy. Recurrent ovarian cancer is currently classified according to sensitivity to platinum-based chemotherapy. Data on targeted therapy provide evidence of improvement with systemic treatment in addition to chemotherapy. Other strategies, although not proven in randomized trials, offer interesting options for future research and therapeutic development. In this review, the covered treatment modalities include surgery, chemotherapy and targeted therapy, immunological approaches and irradiation.
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Affiliation(s)
- Klaus H Baumann
- University Hospital of Giessen & Marburg, Marburg Site, Germany.
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Heitz F, Harter P, Barinoff J, Beutel B, Kannisto P, Grabowski JP, Heitz J, Kurzeder C, du Bois A. Bevacizumab in the treatment of ovarian cancer. Adv Ther 2012; 29:723-35. [PMID: 22941523 DOI: 10.1007/s12325-012-0041-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In the past decade there have been many attempts to improve systemic treatment and thus the outcome of patients with ovarian cancer. However, neither the sequential addition of non cross-resistant drugs to standard chemotherapy comprising carboplatin and paclitaxel, nor triplet combination therapies with conventional chemotherapeutic drugs have improved outcomes. Instead, such approaches have led to an increase in the incidence of side effects. We are currently experiencing a shift toward the addition of molecularly targeted and biological anticancer therapies to standard treatment. Vascular endothelial growth factor (VEGF), which improves vitally important tumor vasculature, is secreted by a range of tumors, and a high level of VEGF is known to be an independent risk factor for aggressive disease in ovarian cancer. This finding led to the development in the 1990s of bevacizumab, a humanized monoclonal antibody against VEGF. DISCUSSION Several phase II trials and four phase III trials have demonstrated that bevacizumab is active in patients with advanced and recurrent ovarian cancer. Both phase III trials of bevacizumab as first-line therapy in advanced ovarian cancer (ICON 7/AGOOVAR 11 and GOG-0218) have shown that the addition of bevacizumab to chemotherapy and as maintenance therapy improves progressionfree survival (PFS). The phase III trials in platinum-sensitive (OCEANS) and platinumresistant, relapsed disease (AURELIA) have also demonstrated a benefit for bevazicumab with respect to PFS. The administration of bevacizumab to improve survival in patients with ovarian cancer is not without side effects and a broad discussion on the cost-effectiveness of this approach is ongoing. CONCLUSION This article presents clinical trial data on bevacizumab in the treatment of ovarian cancer and discusses the indication and pitfalls in the application of bevacizumab in patients with this malignancy.
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Affiliation(s)
- Florian Heitz
- Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssen-Stiftung, Henricistrasse 92, 45136, Essen, Germany.
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