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da Costa AG, Albergaria D, Almeida J, Nave M, Oliveira J, Catarino A, Chi DS, Casanova J. Application of three-dimensional imaging software to map carcinomatosis in recurrent ovarian cancer. J Surg Case Rep 2024; 2024:rjae188. [PMID: 38572284 PMCID: PMC10984731 DOI: 10.1093/jscr/rjae188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
The treatment of recurrent ovarian cancer has been based on systemic therapy. The role of secondary cytoreductive surgery has been addressed recently in several trials. Imaging plays a key role in helping the surgical team to decide which patients will have resectable disease and benefit from surgery. The role of staging laparoscopy and several imaging and clinical scores has been extensively debated in the field. In other surgical fields there have been reports of using 3D imaging software and 3D printed models to help surgeons better plan the surgical approach. To the best of our knowledge, we report the first case of a patient with recurrent ovarian cancer undergoing 3D modeling before secondary cytoreductive surgery. The 3D modeling was of most value to evaluate the extension of the disease in our patient who underwent a successful secondary cytoreductive surgery and is currently free of the disease.
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Affiliation(s)
- Ana Gomes da Costa
- Gynecologic Oncology Unit, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Diogo Albergaria
- Department of General Surgery, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Joana Almeida
- Gynecologic Oncology Unit, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
- Department of Radiology, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Mónica Nave
- Gynecologic Oncology Unit, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
- Department of Oncology, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Joana Oliveira
- Department of Anesthesiology, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Ana Catarino
- Gynecologic Oncology Unit, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
- Department of Pathology, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
| | - Dennis S Chi
- Gynecology Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center, New York, 1275 York Ave, New York, NY 10065, USA
| | - João Casanova
- Gynecologic Oncology Unit, Hospital da Luz, Lisboa, Avenida Lusíada, 100,1500-065, Portugal
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Certelli C, Russo SA, Palmieri L, Foresta A, Pedone Anchora L, Vargiu V, Santullo F, Fagotti A, Scambia G, Gallotta V. Minimally-Invasive Secondary Cytoreduction in Recurrent Ovarian Cancer. Cancers (Basel) 2023; 15:4769. [PMID: 37835463 PMCID: PMC10571765 DOI: 10.3390/cancers15194769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The role of secondary cytoreductive surgery (SCS) in the treatment of recurrent ovarian cancer (ROC) has been widely increased in recent years, especially in trying to improve the quality of life of these patients by utilising a minimally-invasive (MI) approach. However, surgery in previously-treated patients may be challenging, and patient selection and surgical planning are crucial. Unfortunately, at the moment, validated criteria to select patients for MI-SCS are not reported, and no predictors of its feasibility are currently available, probably due to the vast heterogeneity of recurrence patterns. The aim of this narrative review is to describe the role of secondary cytoreductive surgery and, in particular, minimally-invasive procedures, in ROC, analyzing patient selection, outcomes, criticisms, and future perspectives.
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Affiliation(s)
- Camilla Certelli
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Silvio Andrea Russo
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Palmieri
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Aniello Foresta
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Pedone Anchora
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Virginia Vargiu
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Fagotti
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Valerio Gallotta
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Son JH, Kong TW, Park SJ, Lee EJ, Kim HS, Kim NK, Kim Y, Hwang WY, Suh DH, Kim TH, Yang EJ, Shim SH, Chang SJ. Optimum selection criteria for secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer: A multicenter study from the Gynecologic Oncology Research Investigators coLLaborAtion group (GORILLA-3001). J Surg Oncol 2023; 128:645-652. [PMID: 37126413 DOI: 10.1002/jso.27303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND To identify those most likely to benefit from secondary cytoreductive surgery (SCS), we evaluated the survival outcomes and factors predictive of prognosis in patients with recurrent ovarian cancer. METHODS We retrospectively reviewed the medical records of patients with recurrent ovarian cancer treated at five high-volume Korean hospitals between 2010 and 2021. Recurrence characteristics, treatment methods, and potential predictors of survival were compared between the chemotherapy and surgery groups. RESULTS Among all 670 patients, 88.1% had initial stage III/IV disease, and 215 (32.1%) underwent SCS. Among patients who underwent SCS, only those who achieved complete resection exhibited improved survival. Even in patients with residual disease < 1 cm after SCS, we observed no significant survival benefit (p = 0.942). In the multivariate Cox analysis, residual disease at primary surgery, progression-free interval, recurrence sites (≤3 regions or limited carcinomatosis), ascites, and SCS were significant predictors of survival. Meanwhile, the only factor predictive of complete resection after SCS was recurrence sites (p < 0.001). CONCLUSIONS The benefits of SCS appear to be exclusive to cases of complete resection. We propose limited regional platinum-sensitive recurrence (≤3 regions or limited carcinomatosis) without ascites as the optimum selection criteria for SCS.
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Affiliation(s)
- Joo-Hyuk Son
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Tae-Wook Kong
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Kyeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yeorae Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Yeon Hwang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Hun Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Jung Yang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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Climent MT, Serra A, Llueca M, Llueca A. Surgery in Recurrent Ovarian Cancer: A Meta-Analysis. Cancers (Basel) 2023; 15:3470. [PMID: 37444580 DOI: 10.3390/cancers15133470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background: The second cytoreductive surgery performed for a patient who has recurrent ovarian cancer remains controversial. Our study analyzes overall survival (OS) and disease-free survival (DFS) for cytoreductive surgery in addition to chemotherapy in recurrent ovarian cancer instead of chemotherapy alone. Methods: A meta-analysis was conducted using PubMed and the Cochrane database of systematic reviews to select randomized controlled studies. In total, three randomized studies were used, employing a total of 1249 patients. Results: The results of our meta-analysis of these randomized controlled trials identified significant differences in OS (HR = 0.83, IC 95% 0.70-0.99, p < 0.04) and DFS (HR = 0.63, IC 95% 0.55-0.72, p < 0.000001). A subgroup analysis comparing complete cytoreductive surgery and surgery with residual tumor achieved better results for both OS (HR = 0.65, IC 95% 0.49-0.86, p = 0.002) and DFS (HR = 0.67, IC 95% 0.53-0.82, p = 0.0008), with statistical significance. Conclusions: A complete secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) demonstrates an improvement in the OS and DFS, and this benefit is most evident in cases where complete cytoreductive surgery is achieved. The challenge is the correct patient selection for secondary cytoreductive surgery to improve the results of this approach.
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Affiliation(s)
- Maria Teresa Climent
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
| | - Anna Serra
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
| | - Maria Llueca
- Department of Medicine, University CEU-Cardenal Herrera, 12006 Castellon, Spain
| | - Antoni Llueca
- Multidisciplinary Unit of Abdominopelvic Oncology Surgery (MUAPOS), Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
- Oncological Surgery Research Group (OSRG), Department of Medicine, University Jaume I (UJI), 12004 Castellon, Spain
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Singh N, Jayraj AS, Sarkar A, Mohan T, Shukla A, Ghatage P. Pharmacotherapeutic treatment options for recurrent epithelial ovarian cancer. Expert Opin Pharmacother 2023; 24:49-64. [PMID: 35968667 DOI: 10.1080/14656566.2022.2112030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Almost 80% of epithelial ovarian cancer present in advanced stage at diagnosis and despite excellent response to surgery and chemotherapy, more than 70% cancers recur. Subsequent therapies become decreasingly effective in controlling the disease, with each successful therapy being effective for a shorter duration. As a result, there is a need for novel therapeutic strategies to effectively treat recurrence. AREAS COVERED In this extensive literature review of high-quality articles, we have focused on surveillance strategy to detect recurrence early, classification of recurrence based on timeline, role of surgery, chemotherapy, and targeted agents such as anti-angiogenetic drugs, PARP inhibitors, and immune checkpoint inhibitors in platinum-sensitive and platinum-resistant disease, respectively. EXPERT OPINION Recurrent ovarian cancers (ROC) are represented by a heterogenous group of patient population in terms of platinum-free interval (PFI), histology, molecular characteristics and immune recognition. In today's era of precision medicine, chemotherapy should be combined with appropriate targeted agent in a multipronged approach to prolong survival and provide better quality of life outcomes by minimizing side effects.
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Affiliation(s)
- Nilanchali Singh
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | | | - Avir Sarkar
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Trishala Mohan
- Department of Obstetrics and Gynaecology, AIIMS, New Delhi, India
| | - Amlin Shukla
- Division of Reproductive Biology, Indian Council of Medical Research, New Delhi, India
| | - Prafull Ghatage
- Gynaecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Zhu M, Wang J, Wuna Y, Wang Y, Li H. Research progress in the treatment of partial platinum-sensitive recurrent ovarian cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:644-652. [PMID: 34275934 PMCID: PMC10930201 DOI: 10.11817/j.issn.1672-7347.2021.200494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 11/03/2022]
Abstract
Ovarian cancer is a common malignant tumor in gynaecology and its mortality rate is the highest in gynecological cancer. Ovarian cancer patients should face platinum resistance, caused by multiple recurrences. According to the platinum-free interval (PFI), recurrent ovarian cancer can be divided into platinum-resistant (PFI<6 months) and platinum-sensitive (PFI≥6 months). When PFI is 6-12 months, it belongs to the partial platinum-sensitive ovarian cancer. At present, how to prolong the survival of patients with partial platinum-sensitive recurrent ovarian cancer is difficult. Secondary cytoreductive surgery, non-platinum chemotherapy, anti-angiogenesis drugs, and molecular targeted therapy of poly (ADP ribose) polymerase (PARP) inhibitors can improve the prognosis of patients with partial platinum-sensitive recurrent ovarian cancer.
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Affiliation(s)
- Miaochen Zhu
- Collaborative Training Base for Graduate Students of University of South China and Hunan Cancer Hospital, Hengyang Hunan 421001.
| | - Jing Wang
- Gynecological Oncology Research Center of Hunan Cancer Hospital, Changsha 410013, China.
| | - Yiyuan Wuna
- Gynecological Oncology Research Center of Hunan Cancer Hospital, Changsha 410013, China.
| | - Ying Wang
- Gynecological Oncology Research Center of Hunan Cancer Hospital, Changsha 410013, China
| | - He Li
- Gynecological Oncology Research Center of Hunan Cancer Hospital, Changsha 410013, China
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Gadducci A, Simonetti E, Manca G, Guidoccio F, Fanucchi A, Cosio S, Volterrani D. Positron Emission Tomography/Computed Tomography in Platinum-sensitive Recurrent Ovarian Cancer: A Single-center Italian Study. Anticancer Res 2020; 40:2191-2197. [PMID: 32234914 DOI: 10.21873/anticanres.14180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/10/2022]
Abstract
AIM To assess the correlation between contrast-enhanced computed tomography (CE-CT) and positron-emission tomography (PET)/CT results and surgical and pathological findings in patients with recurrent platinum-sensitive ovarian cancer who underwent secondary cytoreduction. PATIENTS AND METHODS 18F-fluorodeoxyglucose (18F-FDG) PET/CT with/without CE-CT were performed before 56 cytoreductive surgeries in 49 patients with suspicious recurrent ovarian cancer. RESULTS 18F-FDG PET/CT showed higher sensitivity and diagnostic accuracy compared with CE-CT for both the whole series (100% versus 90.6%, respectively, and 97.8% versus 85.3%), and the 24 cases in which both examinations were performed (100% versus 87.0% and, respectively, 95.8% versus 83.3%). The addition of CE-CT to 18F-FDG PET/CT did not improve its diagnostic reliability. CONCLUSION 18F-FDG PET/CT appears to be the more reliable imaging technique for the evaluation of patients with suspicious recurrent ovarian cancer, and for the selection of those more suitable for secondary cytoreductive surgery.
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Affiliation(s)
- Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Enrico Simonetti
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Gianpiero Manca
- Regional Center of Nuclear Medicine, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Federica Guidoccio
- Regional Center of Nuclear Medicine, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Antonio Fanucchi
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Stefania Cosio
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, Department of Translational Research, University of Pisa, Pisa, Italy
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Jennifer A, Iptissem N, Aurélie R, Philippe K, Marc AJ. The place of secondary complete cytoreductive surgery in advanced ovarian cancer. Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0030. [PMID: 31782948 DOI: 10.1515/hmbci-2019-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Despite optimal treatment, three-quarters of the patients with advanced ovarian cancer, experiment relapse and its treatment has become a public health issue. Initially debated, surgery is gaining legitimacy in the treatment of late relapse patients, compared to chemotherapy alone. Secondary complete cytoreduction should be proposed only to a highly selected population. The type of surgery depends on the recurrence localization and the relapse extension in the pelvis and to other organs. Innovating techniques of surgery have become widespread including heated intra peritoneal chemotherapy (HIPEC), laparoscopy and robotic surgery. These specialized treatments should only be carried out in reference centers by oncological surgeons.
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Affiliation(s)
- Asmar Jennifer
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Naoura Iptissem
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Revaux Aurélie
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Kadhel Philippe
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France.,CHU de Pointe-à-Pitre, Univ Antilles, Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France
| | - Ayoubi Jean Marc
- Department of Gynecology and Obstetrics, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
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Parashkevova A, Sehouli J, Richter R, Dimitrova D, Braicu EI, Muallem MZ. Preoperative CA-125 Value as a Predictive Factor for Postoperative Outcome in First Relapse of Platinum-sensitive Serous Ovarian Cancer. Anticancer Res 2018; 38:4865-4870. [PMID: 30061261 DOI: 10.21873/anticanres.12799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/18/2018] [Accepted: 04/30/2018] [Indexed: 11/10/2022]
Abstract
AIM The purpose of the study was to evaluate whether preoperative cancer antigen 125 (CA-125) levels predict outcome of secondary cytoreductive surgery (SCS) in patients with serous recurrent ovarian cancer and whether this could be used as a prognostic factor for progression-free (PFS) and overall (OS) survival. PATIENTS AND METHODS A cohort of 111 patients with first recurrence of platinum-sensitive serous ovarian cancer, who had undergone SCS at the Department of Gynecology and Oncological Surgery, Charité, Campus Virchow Clinic was analyzed in correlation with the preoperative CA-125 value. RESULTS The median preoperative CA-125 level was 164 U/ml. Complete tumor resection was achieved in 58.6% of the patients. PFS and OS for patients with preoperative CA-125 of less than 164.5 U/ml was significantly better than those with preoperative CA-125 ≥164.5 U/ml (p=0.025 and p<0.001, respectively). CONCLUSION Preoperative CA-125 is not a statistically significant predictive factor for complete tumor resection after SCS. Preoperative CA-125 <164.5 U/ml can predict significantly better PFS and OS for patients with first recurrence of platinum-sensitive ovarian cancer.
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Affiliation(s)
- Asya Parashkevova
- Ovarian Cancer Tumor Bank, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Rolf Richter
- Department of Gynecology, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Desislava Dimitrova
- Department of Gynecology, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Elena Ioana Braicu
- Ovarian Cancer Tumor Bank, Virchow Campus Clinic, Charité Medical University, Berlin, Germany.,Department of Gynecology, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
| | - Mustafa Zelal Muallem
- Department of Gynecology, Virchow Campus Clinic, Charité Medical University, Berlin, Germany
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10
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Bommert M, Harter P, Heitz F, du Bois A. When should Surgery be used for Recurrent Ovarian Carcinoma? Clin Oncol (R Coll Radiol) 2018; 30:493-497. [PMID: 29743148 DOI: 10.1016/j.clon.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 12/31/2022]
Abstract
Cytoreductive surgery is an important column in the treatment of primary ovarian cancer. Surgical outcome is one of the most important prognostic factors and one of the few prognostic variables that can be influenced by therapists. Retrospective studies suggested that only complete cytoreduction was associated with a benefit. Therefore, definition of predictors of complete resection is of the utmost importance to avoid surgical burden in patients with both limited benefit of the procedure and limited overall life expectancy. Two prospective multicentre randomised surgical trials in platinum-sensitive recurrent ovarian cancer (DESKTOP III [NCT #01166737] and GOG 213 [NSC #704865]) comparing secondary cytoreductive surgery followed by platinum-based chemotherapy versus chemotherapy alone have been conducted. The results of the DESKTOP III were recently presented at the American Society of Clinical Oncology meeting in Chicago. It showed a benefit of secondary cytoreductive surgery exclusively in patients with complete resection with a progression-free survival of 5.6 months (P < 0.001). This overview aims to support this task and concentrates on the currently available data regarding surgery in recurrent ovarian cancer.
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Affiliation(s)
- M Bommert
- Department of Gynecology & Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany.
| | - P Harter
- Department of Gynecology & Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - F Heitz
- Department of Gynecology & Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - A du Bois
- Department of Gynecology & Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
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Nakamura K, Kajiyama H, Utsumi F, Suzuki S, Niimi K, Sekiya R, Sakata J, Yamamoto E, Shibata K, Kikkawa F. Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas. Mol Clin Oncol 2018; 8:499-503. [PMID: 29556383 DOI: 10.3892/mco.2018.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/26/2017] [Indexed: 11/05/2022] Open
Abstract
Uterine sarcomas are some of the most malignant and aggressive tumor types among the gynecologic malignancies, and they are associated with a high rate of recurrence and a poor prognosis. Due to their rarity and diversity, the optimal treatment for recurrent uterine sarcomas has not yet been elucidated. The aim of the present study was to investigate the potential of secondary cytoreductive surgery (SCS) for patients with recurrent uterine sarcomas. A total of 18 patients with recurrent uterine sarcomas were retrospectively identified at the Department of Obstetrics and Gynecology, Nagoya University (Nagoya, Japan) between January 2002 and December 2015. This included 8 patients with leiomyosarcoma, 6 with carcinosarcoma, 3 with endometrial stromal sarcoma and 1 with adenosarcoma. All patients underwent primary debulking surgery as the initial treatment. In summary, 9 patients were treated with SCS when they experienced their first recurrence, and the other 9 patients were treated with non-SCS methods, including chemotherapy or radiotherapy. In the SCS group, 5/9 patients had confined pelvic recurrences, 3 patients had extra-pelvic diseases, including pulmonary metastasis, and one patient had intra- and extra-pelvic recurrence. The 3-year overall survival (OS) rates were 77.8 and 11.1% in the SCS and non-SCS groups, respectively. The patients who underwent SCS experienced a significantly longer OS time compared with those in the non-SCS group (P=0.006). In addition, the disease-free survival after second-line therapy was significantly longer in the SCS group than in the non-SCS group (P=0.0496). These findings suggest that resection of recurrent uterine sarcomas may be beneficial for the improvement of patient survival. Prospective studies with sufficient statistical power are warranted for further evaluation of the effect of SCS.
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Affiliation(s)
- Kenichi Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Fumi Utsumi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Ryuichiro Sekiya
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Jun Sakata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kiyosumi Shibata
- Department of Obstetrics and Gynecology, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya 454-8509, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
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Takahashi A, Kato K, Matsuura M, Katsuda T, Matoda M, Nomura H, Okamoto S, Kanao H, Kondo E, Omatsu K, Utsugi K, Takeshima N. Comparison of secondary cytoreductive surgery plus chemotherapy with chemotherapy alone for recurrent epithelial ovarian, tubal, or peritoneal carcinoma: A propensity score-matched analysis of 112 consecutive patients. Medicine (Baltimore) 2017; 96:e8006. [PMID: 28906381 PMCID: PMC5604650 DOI: 10.1097/md.0000000000008006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To compare secondary cytoreductive surgery (SCS) plus chemotherapy with chemotherapy alone in Japanese patients with recurrent epithelial ovarian, tubal, or peritoneal cancer (ROC).From our institutional database, we identified 112 patients who underwent therapy for ROC between 2005 and 2013. Of the 112 patients, 77 received salvage chemotherapy alone (CT group) and 35 received SCS plus chemotherapy (SCS group). To reduce the impact of treatment selection bias on treatment outcomes, propensity score-matching analysis was used.In the entire cohort, prognostic features were poorer in the CT group than in the SCS group. The platinum-free interval was significantly lower (15.35 months vs 30.77 months), cancer antigen 125 (CA125) level was significantly higher (247.38 IU/mL vs 83.17 IU/mL), and number of solitary recurrence sites was significantly lower in the CT group than in the SCS group. The matched cohort consisted of 29 CT and 29 SCS patients with a median follow-up period of 24 and 58 months, respectively. In the matched cohort, progression-free survival (PFS) was longer in the SCS group than in the CT group (P = .02); however, overall survival did not differ (P = .23).SCS might be associated with improved PFS in ROC patients. SCS is beneficial in appropriately selected ROC patients.
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Nasu K, Kai K, Hirakawa T, Nishida M, Matsumoto H, Kawano Y, Narahara H. Retrospective analysis of outcomes of secondary debulking surgery for recurrent epithelial ovarian cancer with favorable prognostic factors. J Obstet Gynaecol Res 2013; 40:791-6. [PMID: 24245582 DOI: 10.1111/jog.12222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/23/2013] [Indexed: 11/30/2022]
Abstract
AIM Ovarian cancer is the second most common gynecological malignancy, yet it has the highest case-fatality ratio of all gynecologic malignancies. Surgery followed by combination platinum-taxane chemotherapy is the standard approach to the management of primary epithelial ovarian cancer. However, standard treatment of patients with recurrent ovarian cancer remains poorly defined. Secondary cytoreductive surgery (SDS) at the time of relapse has been proposed as a means of improving the prognosis of recurrent ovarian cancer patients with a treatment-free interval of at least 6 months. METHODS In the present study, we retrospectively collected 16 patients with recurrent epithelial ovarian cancer who might benefit most from SDS and evaluated the impact of SDS on the outcomes for this highly select patient group. RESULTS We found that SDS led to excellent outcomes, with a 73.1% 8-year overall survival rate after initial treatment, a 67.9% 5-year overall survival rate after prior SDS, and a 31.3% 5-year progression-free survival rate after prior SDS. Although the findings were not significant, these results suggest that repeated SDS might improve outcomes for this patient group. CONCLUSION The present study may provide a platform for discussion of the impact of aggressive or repeated SDS on the survival of patients with recurrent epithelial ovarian cancer and favorable prognostic factors. Further multi-institutional studies with larger number of patients are mandatory to confirm the present findings.
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Affiliation(s)
- Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan; Division of Obstetrics and Gynecology, Department of Regional Medicine, Faculty of Medicine, Oita University, Oita, Japan
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