Medline ® Abstract for Reference 4
of 'Cancer of the ovary, fallopian tube, and peritoneum: Surgery for recurrent cancer'
The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma.
Eisenkop SM, Friedman RL, Spirtos NM
Cancer. 2000 Jan;88(1):144-53.
BACKGROUND: This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma.
METHODS: One hundred six patients with a disease free interval (DFI)>6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival.
RESULTS: Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (<10 cm¿90.0% vs.>10 cm¿66.7%; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given¿64.3% vs. chemotherapy not given¿93.8%; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0¿100%, 1¿91.4%, 2¿82.4%, and 3¿47.4%; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months¿median, 25.0 months vs. 13-36 months¿median, 44.4 months vs.>36 months¿median, 56.8 months; P = 0.005), the completeness of cytoreduction (visibly disease free¿median, 44.4 months vs. any residual disease¿median, 19.3 months; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given¿median, 24.9 months vs. chemotherapy not given¿median, 48.4 months; P = 0.005), and the largest size of recurrent tumor (<10 cm¿median, 37.3 months vs.>10 cm¿median, 35.6 months; P = 0.04).
CONCLUSIONS: Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.
Womens' Cancer Center: Encino-Tarzana, Tarzana, California, USA.