Positive DESKTOP and Tian Scores Systems Are Adequate to Predict Optimal (R0) Secondary Debulking Surgery in Ovarian Cancer, But a Negative Score Does Not Preclude Secondary Surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 721-728
Author(s):  
Tina Laga ◽  
Sandrina Lambrechts ◽  
Annouschka Laenen ◽  
Els Van Nieuwenhuysen ◽  
Sileny N. Han ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Whole Body ◽  
R0 Resection ◽  
Debulking Surgery ◽  
Predictive Values ◽  
Free Survival ◽  
Negative Score

ObjectiveThe aim of this study was to assess the safety and feasibility of macroscopically complete (R0) secondary debulking surgery (SDS) in a single-center cohort of patients with recurrent ovarian cancer. The performances of existing prediction models (DESKTOP score, Tian model) for R0 SDS were evaluated in this cohort.MethodsPatient, disease, and treatment characteristics of 102 patients undergoing SDS for recurrent ovarian cancer at the University Hospitals Leuven between 1997 and 2014 were collected.ResultsR0 SDS was achieved in 73% of patients and associated with improved progression-free survival (P = 0.0002) and overall survival (P = 0.0003) compared with non-R0 resection. Variables associated with R0 SDS were site of relapse (P = 0.046) and absence of ascites (P = 0.045). The DESKTOP score and Tian model showed positive predictive values for R0 SDS of 80% and 73%, respectively. However, a false-negative rate for R0 resection of 61% and 70% was observed in our study. Progression-free survival and overall survival did not significantly differ between DESKTOP score–positive and –negative patients with R0 SDS.ConclusionsWe confirmed a high positive predictive value in the selection of candidates for R0 SDS with the DESKTOP score and the Tian model. However, because 61% and 70% of the patients with a negative score were debulked to R0, we suggest that other selection criteria based on anatomic and metabolic imaging such as whole-body diffusion-weighted magnetic resonance imaging should be evaluated when selecting patients for SDS.

Delays from neoadjuvant chemotherapy to interval debulking surgery and survival in ovarian cancer

2020 ◽  
Vol 30 (10) ◽  
pp. 1554-1561
Author(s):  
Ying L Liu ◽  
Qin C Zhou ◽  
Alexia Iasonos ◽  
Olga T Filippova ◽  
Dennis S Chi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Debulking Surgery ◽  
Free Survival ◽  
Interval Debulking Surgery ◽  
The Impact

IntroductionDelays from primary surgery to chemotherapy are associated with worse survival in ovarian cancer, however the impact of delays from neoadjuvant chemotherapy to interval debulking surgery is unknown. We sought to evaluate the association of delays from neoadjuvant chemotherapy to interval debulking with survival.MethodsPatients with a diagnosis of stage III/IV ovarian cancer receiving neoadjuvant chemotherapy from July 2015 to December 2017 were included in our analysis. Delays from neoadjuvant chemotherapy to interval debulking were defined as time from last preoperative carboplatin to interval debulking >6 weeks. Fisher’s exact/Wilcoxon rank sum tests were used to compare clinical characteristics. The Kaplan–Meier method, log-rank test, and multivariate Cox Proportional-Hazards models were used to estimate progression-free and overall survival and examine differences by delay groups, adjusting for covariates.ResultsOf the 224 women, 159 (71%) underwent interval debulking and 34 (21%) of these experienced delays from neoadjuvant chemotherapy to interval debulking. These women were older (median 68 vs 65 years, P=0.05) and received more preoperative chemotherapy cycles (median 6 vs 4, P=0.003). Delays from neoadjuvant chemotherapy to interval debulking were associated with worse overall survival (HR 2.4 95% CI 1.2 to 4.8, P=0.01), however survival was not significantly shortened after adjusting for age, stage, and complete gross resection, HR 1.66 95% CI 0.8 to 3.4, P=0.17. Delays from neoadjuvant chemotherapy to interval debulking were not associated with worse progression-free survival (HR 1.55 95% CI 0.97 to 2.5, P=0.062). Increase in number of preoperative cycles (P=0.005) and lack of complete gross resection (P<0.001) were the only variables predictive of worse progression-free survival.DiscussionDelays from neoadjuvant chemotherapy to interval debulking were not associated with worse overall survival after adjustment for age, stage, and complete gross resection.

Nonplatinum Topotecan Combinations Versus Topotecan Alone for Recurrent Ovarian Cancer: Results of a Phase III Study of the North-Eastern German Society of Gynecological Oncology Ovarian Cancer Study Group

2008 ◽  
Vol 26 (19) ◽  
pp. 3176-3182 ◽  
Author(s):  
Jalid Sehouli ◽  
Dirk Stengel ◽  
Guelten Oskay-Oezcelik ◽  
Alain G. Zeimet ◽  
Harald Sommer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ovarian Cancer ◽  
Overall Survival ◽  
Objective Response ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Free Survival ◽  
Platinum Sensitive ◽  
Platinum Refractory

PurposeThe management of recurrent ovarian cancer remains controversial. Single-agent topotecan is an established treatment option, and preliminary evidence suggests improved tumor control by combining topotecan with etoposide or gemcitabine.Patients and MethodsWomen with relapsed ovarian cancer after primary surgery and platinum-based chemotherapy were randomly assigned to topotecan monotherapy 1.25 mg/m2/d, topotecan 1.0 mg/m2plus oral etoposide 50 mg/d, or topotecan 0.5 mg/m2/d plus gemcitabine 800 mg/m2on day 1 and 600 mg/m2on day 8 every 3 weeks. Patients were stratified for platinum-refractory and platinum-sensitive disease according to a recurrence-free interval of less or more than 12 months, respectively. The primary end point was overall survival. Secondary end points included progression-free survival, objective response rates, toxicity, and quality of life (as measured by the European Organisation for Research and Treatment of Cancer [EORTC] 30-item Quality-of-Life Questionnaire).ResultsThe trial enrolled 502 patients with a mean age of 60.5 years (± 10.2 years), 208 of whom were platinum resistant. Median overall survival was 17.2 months (95% CI, 13.5 to 21.9 months) with topotecan, 17.8 months (95% CI, 13.7 to 20.0 months) with topotecan plus etoposide (log-rank P = .7647), and 15.2 months (95% CI, 11.3 to 20.9 months) with topotecan plus gemcitabine (log-rank P = .2344). Platinum-sensitive patients lived significantly longer than platinum-refractory patients (21.9 v 10.6 months). The median progression-free survival was 7.0, 7.8, and 6.3 months, respectively. Objective response rates were 27.8%, 36.1%, and 31.6%, respectively. Patients under combined treatment were at higher risk of severe thrombocytopenia.ConclusionNonplatinum topotecan combinations do not provide a survival advantage over topotecan alone in women with relapsed ovarian cancer.

scholarly journals Management of the Elderly Patients with High-Grade Serous Ovarian Cancer in the REAL-WORLD Setting

2021 ◽  
Vol 28 (2) ◽  
pp. 1143-1152
Author(s):  
Michalis Liontos ◽  
Alkistis Papatheodoridi ◽  
Angeliki Andrikopoulou ◽  
Nikolaos Thomakos ◽  
Dimitrios Haidopoulos ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Optimal Treatment ◽  
High Grade ◽  
Serous Ovarian Cancer ◽  
Debulking Surgery ◽  
Free Survival

Treatment of elderly patients with neoplasia is challenging. Age is a known prognostic factor in ovarian cancer but the optimal treatment of elderly patients has not been determined. We undertook a retrospective analysis to determine clinical practice in advanced-stage ovarian cancer patients older than 70 years of age. Methods: Medical records of women with high-grade serous ovarian cancer, stage III and IV were retrospectively analyzed. Results: A total of 735 patients were identified with a median age of 61.5 years. 22.4% among them were older than 70 years of age at diagnosis. First-line Progression-Free Survival (PFS) and Overall Survival (OS) were significantly worse in elderly patients in comparison to the younger ones [mPFS 11.3 months vs. 14.8 months, (p < 0.001) and mOS 30.2 months vs. 45.6 months (p < 0.001)]. However, elderly patients were characterized by worse ECOG-Performance Status and they were more frequently treated with Neoadjuvant Chemotherapy followed by Interval Debulking Surgery, while often they were more frequently denied debulking surgery compared to patients under 70 years of age. Moreover, elderly patients received more frequently monotherapy with platinum as frontline treatment. In contrast, there was no significant difference in the outcome of the debulking surgery in comparison to the younger patients or the frequency that gBRCA test was performed. Age over 70 years did not retain its significance for either Progression-Free Survival or Overall Survival when adjusted for all other reported prognostic factors. Conclusions: Elderly ovarian cancer patients have a worse prognosis. Comprehensive geriatric assessment should be performed for the optimal treatment of these patients.

Cytoreductive surgery followed by chemotherapy and olaparib maintenance in BRCA 1/2 mutated recurrent ovarian cancer: a retrospective MITO group study

2021 ◽  
pp. ijgc-2020-002343
Author(s):  
Sabrina Chiara Cecere ◽  
Lucia Musacchio ◽  
Michele Bartoletti ◽  
Vanda Salutari ◽  
Laura Arenare ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Cytoreductive Surgery ◽  
Response Rate ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Free Survival ◽  
Platinum Sensitive ◽  
Free Interval ◽  
Platinum Based Chemotherapy

IntroductionThe role of cytoreductive surgery in the poly-ADP ribose polymerase inhibitors era is not fully investigated. We evaluated the impact of surgery performed prior to platinum-based chemotherapy followed by olaparib maintenance in platinum-sensitive BRCA-mutated recurrent ovarian cancer.MethodsThis retrospective study included platinum-sensitive recurrent ovarian cancer BRCA-mutated patients from 13 Multicenter Italian Trials in Ovarian cancer and gynecological malignancies centers treated between September 2015 and May 2019. The primary outcomes were progression-free survival and overall survival. Data on post-progression treatment was also assessed.ResultsAmong 209 patients, 72 patients (34.5%) underwent cytoreductive surgery followed by platinum-based chemotherapy and olaparib maintenance, while 137 patients (65.5%) underwent chemotherapy treatment alone. After a median follow-up of 37.3 months (95% CI: 33.4 to 40.8), median progression-free survival in the surgery group was not reached, compared with 11 months in patients receiving chemotherapy alone (P<0.001). Median overall survival was nearly double in patients undergoing surgery before chemotherapy (55 vs 28 months, P<0.001). Post-progression therapy was assessed in 127 patients: response rate to chemotherapy was 29.2%, 8.8%, and 9.0% in patients with platinum-free interval >12 months, between 6 and 12 months, and <6 months, respectively.ConclusionCytoreductive surgery performed before platinum therapy and olaparib maintenance was associated with longer progression-free survival and overall survival in BRCA-mutated platinum-sensitive relapsed ovarian cancer patients. In accordance with our preliminary results, the response rate to chemotherapy given after progression during olaparib was associated with platinum-free interval.

scholarly journals Robotic-assisted laparoscopic splenectomy for recurrent ovarian cancer

2020 ◽  
Vol 30 (8) ◽  
pp. 1189-1194
Author(s):  
Thomas A Paterniti ◽  
Sarfraz Ahmad ◽  
Robert W Holloway
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Length Of Stay ◽  
Median Time ◽  
Laparoscopic Splenectomy ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Port Placement ◽  
Free Survival ◽  
Robotic Assisted

PurposeRecurrent ovarian cancer frequently involves the spleen. Our aims were to describe the technique of robotic-assisted laparoscopic splenectomy and to evaluate outcomes including progression-free and overall survival in patients who underwent this procedure for recurrent ovarian cancer.MethodsChart reviews were performed on all consecutive patients who underwent robotic splenectomy (April 2012 to May 2019) for recurrent ovarian cancer. Patients had ≤3 sites of disease and no ascites. Extent of disease was confirmed by positron emission tomography-computed tomography (PET-CT) pre-operatively and platinum-doublet chemotherapy was initiated post-operatively. Peri- and post-operative outcomes, progression-free survival, and overall survival were assessed. Two video links are included to demonstrate variations in technique and anatomy.ResultsA total of 10 patients were included. The median age was 63.5 years (range 46–74) and median body mass index was 30 kg/m2 (range 21.5–40.1). Disease was limited to the spleen in seven patients and three had evidence of up to two other sites of disease on imaging. The median robotic splenectomy operative time was 159 min (range 112–214) that included laparoscopic lysis of adhesions prior to robotic port placement in seven cases, and excision of diaphragm or omental implants in three cases. There were no transfusions, laparotomy conversions, return to the operating room, abscesses, or pancreatic pseudocysts. The median length of stay was 2 days (range 1–4). The median time to resumption of chemotherapy was 40 days (range 25–78). After a median follow-up of 51 months (range 12–98), five patients had recurrence (two deaths, three alive with disease), with a median time to recurrence of 14 months (range 12–15). The median progression-free survival was 15 months (range 12–98) and the median overall survival was 51 months (range 12–98) post-splenectomy.ConclusionsRobotic splenectomy was feasible, achieving complete cytoreduction of splenic recurrent ovarian cancer, short hospital length-of-stay, and acceptable morbidity.

scholarly journals Metronomic oral cyclophosphamide in relapsed ovarian cancer

2021 ◽  
pp. ijgc-2021-002467
Author(s):  
Pavlina Spiliopoulou ◽  
Samantha Hinsley ◽  
Iain A McNeish ◽  
Patricia Roxburgh ◽  
Ros Glasspool
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Gynecologic Cancer ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Clinical Activity ◽  
Platinum Resistance ◽  
Free Survival ◽  
Disease Response ◽  
Metronomic Cyclophosphamide

ObjectivesTo describe the clinical activity of metronomic cyclophosphamide in a population of patients with recurrent ovarian cancer, and to identify predictors of clinical response.MethodsWe retrospectively reviewed all patients treated at our institution with oral metronomic cyclophosphamide for relapsed ovarian cancer between January 2012 and December 2016. These were identified from electronic chemotherapy prescription records. The primary endpoint was response rate by combined Gynecologic Cancer InterGroup (GCIG) criteria. Data on patient demographics, previous therapies, platinum resistance, germline BRCA1/2 (gBRCA1/2) status, disease response by radiological or cancer antigen 125 (CA125) criteria alone, adverse events secondary to metronomic cyclophosphamide treatment, progression-free survival, and overall survival were also evaluated.Results50 out of 68 patients treated with oral metronomic cyclophosphamide were evaluable for disease response. By combination criteria (radiological plus CA125), complete response was 0%, partial response 32%, stable disease 16%, and progressive disease 52%. In the intention-to-treat population (n=68), progression-free survival and overall survival were 2.6 months and 6 months, respectively. Having a gBRCA1/2 mutation reduced the risk of disease progression by radiological criteria (OR 0.07, 95% CI 0.008 to 0.67, p=0.02), and patients with gBRCA1/2 mutations had improved progression-free survival (7.9 vs 2.5 months, HR 0.4, 95% CI 0.23 to 0.74, p=0.003) and overall survival (15.5 vs 6 months, HR 0.49, 95% CI 0.28 to 0.85, p=0.02) with metronomic cyclophosphamide when compared with patients without gBRCA1/2 mutations (or unknown gBRCA1/2 status).ConclusionOral metronomic cyclophosphamide showed a clinical benefit in 48% of patients with recurrent ovarian cancer. gBRCA1/2 status can be an independent predictor of response.

Is adjuvant chemotherapy after secondary debulking surgery for recurrent ovarian cancer necessary?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16507-e16507
Author(s):  
Munetaka Takekuma ◽  
Keita Mori ◽  
Satomi Komeda ◽  
Shiho Kuji ◽  
Aki Tanaka ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Chemotherapy ◽  
Disease Progression ◽  
Selection Criterion ◽  
Progression Free Survival ◽  
Recurrent Ovarian Cancer ◽  
Debulking Surgery ◽  
Free Survival ◽  
Median Progression Free Survival ◽  
Serum Ca125

e16507 Background: Secondary debulking surgery (SDS) for recurrent ovarian cancer is recognized as a valuable options. However, to our knowledge, the value of chemotherapy after SDS has not been reported. Methods: Between November 2003 and November 2011, 30 patients with recurrent ovarian cancer underwent SDS at our hospital. We statistically analyzed which variables influenced survival. Results: After SDS, the median follow-up was 22.9 months, and the median survival was 26.7 months (range, 0.1-61 months). Twenty-five patients (83.3%) had no residual tumor after SDS. With Fisher's exact method, the patients who had serum CA125 levels ≥ 40 U/ml tended to show disease progression after SDS (p = 0.13). Adjuvant chemotherapy after SDS had no significant clinical benefit with regard to disease progression (p = 0.25). Moreover, log-rank test showed median progression free survival to be 31.8 months for patients who had serum CA125 levels < 40 U/ml as compared with 8.9 months for patients who had serum CA125 levels ≥ 40 U/ml (p = 0.0351). For patients who received adjuvant chemotherapy after SDS, the median progression free survival was 13.0 months, versus 8.0 months for patients not given adjuvant chemotherapy after SDS (p = 0.5871). Conclusions: We suggest that a serum CA125 level < 40 U/ml should be used as a selection criterion for offering SDS. Adjuvant chemotherapy after SDS does not appear to prolong survival. We advocate that a randomized trial to verify the necessity of chemotherapy after SDS be initiated to confirm this finding.

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