Clinical trials in patients with epithelial ovarian cancer: past, present and future (original) (raw)
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The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review
It has already been proven that ovarian cancer is the sixth most common cancer among women, and it is considered the leading cause of death by gynecologic cancer in developed countries. This article is a literature review based on the use of cytoreductive surgery matched with adjuvant chemotherapy in advanced-stage ovarian cancer. According to the statistics, the difficulty of obtaining an early diagnosis results in a delay in the disease treatment and as a consequence, in many cases, ovarian cancer is still diagnosed in the advanced stage of the disease. Primary surgery is performed, in addition to diagnosis and staging, to achieve optimal cytoreduction. The purpose of this article is to review the different surgical approaches in the management of epithelial ovarian cancer, specifically the high-stage disease, with a special concentration on the most recent therapeutic additions to our current knowledge, such as hyperthermic intraperitoneal chemotherapy and new therapeutic drugs. ...
Cancers, 2020
Objective: to analyze the evolution of surgical techniques and strategies, and to determine their influence on the survival of patients with stage III or IV epithelial ovarian cancer (EOC). Methods: a retrospective data analysis was performed in two French tertiary cancer institutes. The analysis included clinical information, cytoreductive outcome (complete, optimal and suboptimal), definitive pathology, Overall Survival (OS), and Progression-Free Survival (PFS). Three surgical strategies were compared: Primary Cytoreductive Surgery (PCS), Interval Cytoreductive Surgery (ICS) after three cycles of Neo-Adjuvant Chemotherapy (NAC), and Final Cytoreductive Surgery (FCS) after at least six cycles of NAC. We analyzed four distinct time intervals: prior to 2000, between 2000 and 2004, between 2005 and 2009, and after 2009. Results: data from 1474 patients managed for International Federation of Gynecology and Obstetrics (FIGO) stages III (80%) or IV (20%) EOC were analyzed. Throughout th...
European Journal of Surgical Oncology (EJSO), 2009
The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Nevertheless, there is still the question as to the extent and timing of the surgical debulking. The aim of this study was to evaluate the place of surgery in the therapeutic sequence. Patients and methods: We reviewed data from all consecutive patients with stage IIIC and IV epithelial ovarian cancer, operated on at our institution between 1990 and 2005. Patients were divided into 2 groups, according to the position of surgery in the therapeutic sequence. Patients in group 1 received initial debulking surgery. Group 2 consisted of patients having received their first debulking after initial chemotherapy. Results: Two hundred and three patients were identified and frequently underwent aggressive surgery, in particular, digestive surgery with bowel resections. Perioperative mortality and morbidity rates were low (2% and 14%, respectively) and there was no difference between the groups. Overall survival in group 1 for patients with complete cytoreduction (residual disease (RD) ¼ 0), optimal surgery (RD < 1 cm) or sub-optimal surgery (RD > 1 cm) was 50%, 30% and 14%, respectively. In group 2, overall survival following complete surgery was 30%, and no long-term survival was observed when surgery was not complete at the time of interval surgery. Survival was worse for patients who had received more than 4 cycles of neoadjuvant chemotherapy. Conclusion: This study confirms the importance of surgery in the prognosis of advanced ovarian cancer. Only the patient subgroup that underwent complete initial or interval surgery was associated with a prolonged remission. Optimal surgery with a controlled morbidity can be achieved in many cases, even if bowel resection is needed, at the time of primary debulking. In the interval cytoreductive surgery subgroup, the response to initial chemotherapy and surgery was found to be essential for prognosis.
Cancer, 1996
To assess the risks and benefits of secondary surgical cytoreduction for advanced epithelial ovarian cancer. Searching MEDLINE was searched (search dates are unclear and search strategies are unspecified), and reference lists from original research and review articles were examined. The search appears to have been restricted to English language literature. Study selection Study designs of evaluations included in the review The inclusion criteria relating to study design were not clearly specified. Among the included studies were randomised and non-randomised controlled trials, retrospective comparative studies and case series. Specific interventions included in the review Surgical interventions to remove or debulk epithelial ovarian tumours. Participants included in the review Women with ovarian cancer who either: have a recurrence of the cancer after a clinical disease-free interval of over 6 months; are clinically and radiologically free of ovarian cancer after primary surgery and chemotherapy, but who are found to have macroscopic disease at second-look laparotomy; have a bulky, unresectable tumour discovered during initial surgery and undergo interval cytoreductive surgery after neoadjuvant chemotherapy; or have evidence of clinical disease progression while receiving first-line therapy. Outcomes assessed in the review The outcome was survival (either median survival in months, or percentage survival to up to 5 years). Morbidity associated with surgery was also recorded. How were decisions on the relevance of primary studies made? The authors do not state how the papers were selected for the review, or how many of the authors performed the selection. Methods of synthesis How were the studies combined? The impact of secondary cytoreductive surgery on four types of patients (women with a recurrence of the cancer after a clinical disease-free interval of over 6 months; women clinically and radiologically free of ovarian cancer after primary surgery and chemotherapy, but who were found to have macroscopic disease at second-look laparotomy; women with a
Annals of Surgical Oncology, 2012
Background. The value of surgery for recurrent epithelial ovarian cancer (OC) is controversial. The aim of the present study was to evaluate the outcome of EOC-patients who underwent tertiary cytoreductive surgery (TCS) and to identify prognostic markers for complete tumor resection and survival. Methods. Retrospective multicenter evaluation of TCS patients treated between 1997 and 2011 in 14 centers across Europe, the United States, and Asia. Results. We evaluated 406 patients (median age, 55 years; range, 16-80 years). Median time from first to second recurrence was 18 months (2-204 months). Median followup from TCS was 14 months (0-182 months), and median OS was 26 months (95 % CI, 19.62-32.38 months). Median OS for patients without versus any tumor residuals was 49 months (95 % CI, 42.5-56.4 months) versus 12 months (95 % CI 9.3-14.7 months) (p \ 0.001). The majority of the patients had an advanced initial FIGO stage III/IV (69 %), peritoneal carcinomatosis (51.7 %), and absence of ascites (72.2 %). A total of 224 patients (54.1 %) underwent complete tumor resection. The most frequent tumor dissemination site was the pelvis (73 %). Rates of major operative morbidity and 30-day mortality were 25.9 % and 3.2 %, respectively. Multivariate analysis identified platinum resistance, tumor residuals at secondary surgery, and peritoneal carcinomatosis to be of predictive significance for complete tumor resection, while tumor residuals at secondary and tertiary surgery, decreasing interval to second relapse, ascites, upper abdominal tumor involvement, and nonplatinum third-line chemotherapy significantly affected OS. Conclusions. In this largest known database for TCS, residual tumor retains its high impact on survival even in the tertiary setting of OC. In specialized centers high rates of complete tumor resection can be obtained. Prospective analyses are warranted to define the value of TCS in EOC. In the last 4 decades the evolution of surgical treatment of epithelial ovarian cancer (EOC) has been distinguished by increasing radicality through incorporation of multivisceral resection techniques that aim at resection of all
Randomized Trial of Cytoreductive Surgery for Relapsed Ovarian Cancer
New England Journal of Medicine, 2021
BACKGROUND Treatment for patients with recurrent ovarian cancer has been mainly based on systemic therapy. The role of secondary cytoreductive surgery is unclear. METHODS We randomly assigned patients with recurrent ovarian cancer who had a first relapse after a platinum-free interval (an interval during which no platinum-based chemotherapy was used) of 6 months or more to undergo secondary cytoreductive surgery and then receive platinum-based chemotherapy or to receive platinumbased chemotherapy alone. Patients were eligible if they presented with a positive Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score, defined as an Eastern Cooperative Oncology Group performance-status score of 0 (on a 5-point scale, with higher scores indicating greater disability), ascites of less than 500 ml, and complete resection at initial surgery. A positive AGO score is used to identify patients in whom a complete resection might be achieved. The primary end point was overall survival. We also assessed quality of life and prognostic factors for survival. RESULTS A total of 407 patients underwent randomization: 206 were assigned to cytoreductive surgery and chemotherapy, and 201 to chemotherapy alone. A complete resection was achieved in 75.5% of the patients in the surgery group who underwent the procedure. The median overall survival was 53.7 months in the surgery group and 46.0 months in the no-surgery group (hazard ratio for death, 0.75; 95% confidence interval, 0.59 to 0.96; P = 0.02). Patients with a complete resection had the most favorable outcome, with a median overall survival of 61.9 months. A benefit from surgery was seen in all analyses in subgroups according to prognostic factors. Quality-of-life measures through 1 year of follow-up did not differ between the two groups, and we observed no perioperative mortality within 30 days after surgery. CONCLUSIONS In women with recurrent ovarian cancer, cytoreductive surgery followed by chemotherapy resulted in longer overall survival than chemotherapy alone. (Funded by the AGO Study Group and others; DESKTOP III ClinicalTrials.gov number, NCT01166737.
Surgery for patients with newly diagnosed advanced ovarian cancer: which patient, when and extent?
Current Opinion in Oncology, 2017
Purpose of review Cytoreduction to no residual disease is the mainstay of primary treatment for advanced epithelial ovarian cancer (AdvEOC). This review addresses recent insights on optimal patient selection, timing and extent of surgery, intended to optimize cytoreduction in patients with AdvEOC. Recent findings Clinical guidelines recommend primary cytoreductive surgery for AdvEOC patients with a high likelihood of achieving complete cytoreduction with acceptable morbidity. In line with this, preoperative prediction markers such as CA-125, histologic and genomic factors, innovative imaging modalities and the performance of a diagnostic laparoscopy have been suggested to improve clinical decision-making with regard to optimal timing of cytoreductive surgery. To determine whether these strategies should be incorporated into clinical practice validation in randomized clinical trials is essential.