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« Back to Contents OVARIAN CANCER

LiFE re

Literature for ENYGO

Surgical treatment of recurrent ovarian cancer

Editor Patriciu Achimas-Cadariu A high-volume U.S. centre recently evaluated the predictive value
of the AGO score in patients undergoing secondary cytoreductive
Descriptive summary surgery (SCS) for recurrent ovarian cancer, in 192 patients. A positive
score correlated well with complete cytoreduction (84 %), but the
Within the search period no randomised phase III trials have been negative predictive value was low and suggested that refinement of
published and results of DESKTOP III (NCT01166737), GOG 213 the score is needed (disease-free interval and number of recurrence
(NCT00565851), and SOCceR (NTR3337) are still awaited to clarify sites could increase the predictive value) [5].
some important issues within this field of gynaecologic oncology.
HIPEC (hyperthermic intraperitoneal chemotherapy)
A single-centre study presented its data with regard to secondary
cytoreductive surgery in patients with platinum-resistant ovarian The use of HIPEC in treating peritoneal carcinomatosis is still
cancer. The estimated 5-year overall survival rates were 57 % versus controversial, and a single-centre comparative retrospective analysis
23.5 %, in favour of patients who had undergone surgery. However, of secondary cytoreductive surgery (SCS) versus SCS+HIPEC did not
these results must be interpreted with caution, given the small find any difference in survival between groups, although the second
sample size and retrospective nature [1]. group had a significantly longer hospital stay and more NCI grade
III-IV morbidity [6]. On the contrary, within a highly selected group
For patients with isolated platinum-sensitive splenic relapse, optimal of platinum-sensitive recurrent ovarian cancer patients treated with
secondary cytoreduction with minimally invasive surgical technique secondary cytoreductive surgery plus HIPEC, another study demon-
by a well-trained surgeon is feasible, as reported by this prospective strated favourable 5- and 7-year post relapse survival rates of 52.8
study (Gallota et al.). The authors reported limited intraoperative and 44.7 %, respectively, without long-term sequelae, indicating the
blood loss, a shorter hospital stay, and a shorter interval (median 16 need for further randomised data [7].
days) from surgery to adjuvant chemotherapy [2].

Van de Laar et al. retrospectively studied outcome after secondary
cytoreductive surgery in 38 Dutch hospitals [3]. 408 patients were
included based on the criterion of two consecutive histopathological
reports with at least 6 months in between. Patients were treated in
hospitals that had at least 20 primary debulking surgeries annually.
The study reports favourable outcomes after complete cytoreduction,
but because of the retrospective design this study is prone to selec-
tion bias and results need to be interpreted with caution.

Prediction of optimal cytoreduction

The SeC-Score, a predictive score for platinum-sensitive recurrent
ovarian cancer, was developed in a single-centre study to bet-
ter predict optimal secondary cytoreduction. After radiologically
documented relapse with a progression-free interval ≥12 months, a
number of four variables (residual tumour at primary cytoreduction,
preoperative CA-125 and HE4, ascites) were combined into a logistic
regression model, with a sensitivity and specificity of 82 % and
83 %, respectively (PPV = 0.79, NPV = 0.81). However, explorative
laparotomy determined if patients underwent secondary debulking
or chemotherapy [4].

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International Journal of Gynecological Cancer, Volume 26, Supplement #1