Significance of postoperative CA-125 decline after cytoreductive surgery in stage IIIC/IV ovarian cancer

5058 Background: Nomograms have been developed for numerous malignancies to predict a specific individual’s probability of long-term survival based on known prognostic factors. To date, no prediction model has been developed for patients with ovarian cancer. The objective of this study was to develop a nomogram to predict the probability of 4-year survival after primary cytoreductive surgery for bulky stage IIIC ovarian carcinoma. Methods: Nomogram predictor variables included age, tumor grade, histologic type, preoperative platelet count, the presence or absence of ascites, and residual disease status after primary cytoreduction. Disease-specific survival was estimated using the Kaplan-Meier method. Cox proportional hazards regression was used for multivariable analysis. The Cox model was the basis for the nomogram. The concordance index was used as an accuracy measure, with bootstrapping to correct for optimistic bias. Calibration plots were constructed. Results: A total of 462patients with bulky stage IIIC ovarian carcinoma underwent primary cytoreductive surgery at our institution during the study period of 1/89 to 12/03, of whom 397 were evaluable for inclusion in the study. The median age of the study population was 60 years (range 22–87). The primary surgeon in all cases was an attending gynecologic oncologist. Postoperatively, all patients received platinum-based systemic chemotherapy. Ovarian cancer-specific survival at 4 years was 51%. A nomogram was constructed on the basis of a Cox regression model and the 6 predictor variables. This nomogram was internally validated using bootstrapping and shown to have excellent calibration with a bootstrap-corrected concordance index of 0.67. Conclusions: A nomogram was developed to predict 4-year disease-specific survival after primary cytoreductive surgery for bulky stage IIIC ovarian carcinoma. The nomogram utilizes 6 predictor variables that are readily accessible, assigns a point value to each variable, and then predicts the probability of 4-year survival based on the total point value for an individual patient. This tool should be useful for patient counseling, clinical trial eligibility determination, postoperative management, and follow-up. No significant financial relationships to disclose.

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Phase II study of intraperitoneal submicron particle paclitaxel (SPP) plus IV carboplatin and paclitaxel in patients with epithelial ovarian cancer undergoing cytoreductive surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18046 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18046-e18046

Author(s):

Sally Anne Mullany ◽

David S. Miller ◽

Katina Robison ◽

Kimberly Levinson ◽

Yi-Chun Lee ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cytoreductive Surgery ◽

Study Drug ◽

Complete Response ◽

Submicron Particles ◽

Ca 125 ◽

Local Toxicity ◽

Nonsurgical Patients ◽

Dose Levels

e18046 Background: Although advances in chemotherapy, cytoreductive surgery, and maintenance therapy (SOC) improved PFS for high grade epithelial ovarian cancer, > 20% of patients relapse during the first 6 months and 60% relapse after 6 months. Submicron particles (~800 nm) of paclitaxel (SPP) contain 1-2 billion molecules of pure drug that release tumoricidal levels of paclitaxel over many weeks. In a previous trial, percutaneous instillations of SPP in nonsurgical patients with intraperitoneal cancer were associated with reduced systemic and local toxicity as compared to standard chemotherapy regimens. (Williamson et al Cancer Chemo Pharm (2015) 75:1075). Methods: This study compared two dose-levels of IP SPP instilled in 200 ml of saline post-cytoreductive surgery. Eligible patients with primary (n = 6) or recurrent (n = 4) epithelial ovarian cancer who underwent complete cytoreductive surgery were enrolled to receive a single instillation of IP SPP followed by standard IV carboplatin and paclitaxel. Endpoints were PFS and evaluation of treatment-emergent adverse events. Clinical response was determined by CT scans and serum CA-125 measurements. Results: Of the 24 subjects screened, 10 were enrolled and received treatment: seven patients received 100 mg/m2 and three received 200 mg/m2. For analysis purposes, 7 out of 10 subjects were evaluable (1 withdrew, 1 died unrelated to study drug during IV treatment and 1 was unevaluable). Upon completion of planned chemotherapy post-SPP instillation, the PFS at 6 months was 66% (4/6) and at 12-months 66% (4/6) using RECIST 1.1. One subject had a complete response at the end of IV treatment, but died (unrelated to study treatment) before PFS evaluation. There was one case of incision dehiscence and one case of vaginal cuff leakage after surgery. Conclusions: This pilot study supports further evaluation of IP SPP to treat peritoneal carcinomas. Clinical trial information: NCT03029585.

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Optimisation of Cytoreductive Surgery in Relation to Ca 125 in Epithelial Ovarian Cancer

Indian Journal of Gynecologic Oncology ◽

10.1007/s40944-018-0181-1 ◽

2018 ◽

Vol 16 (1) ◽

Author(s):

K. Shobha ◽

Natarajan Jayashree ◽

U. D. Bafna

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Cytoreductive Surgery ◽

Ca 125

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Percutaneous Radiofrequency Ablation Combined With Chemotherapy Versus Chemotherapy Only for Ovarian Cancer Liver Metastasis

Frontiers in Oncology ◽

10.3389/fonc.2021.793024 ◽

2022 ◽

Vol 11 ◽

Author(s):

Chun-Xue Wu ◽

Miao-Ling Chen ◽

Hao Zhang ◽

Jian-Jun Han

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Retrospective Study ◽

Radiofrequency Ablation ◽

Liver Metastasis ◽

Cytoreductive Surgery ◽

Ca 125 ◽

Percutaneous Radiofrequency Ablation ◽

Chemotherapy Group ◽

Effective Option

PurposeTo compare the feasibility and efficacy of radiofrequency ablation (RFA) combined with chemotherapy and chemotherapy alone in patients with ovarian cancer liver metastasis (OCLM).MethodsIn this retrospective study, a total of 60 patients diagnosed with OCLM between May 2015 to February 2017 were included. All patients with ovarian cancer received chemotherapy and primary cytoreductive surgery before. Thirty patients underwent RFA and chemotherapy, and thirty patients only took chemotherapy. The overall survival (OS), CA-125 levels, and serum AST and ALT levels were compared between the two groups.ResultsIn the RFA group, the 1-,2-, and 3-year OS rates after RFA were 93.3%, 80.0%, and 53.3%, respectively. Serum AST and ALT levels were both elevated after RFA (p=0.0004, p<0.0001). In the chemotherapy group, the 1-,2-, and 3-year OS rates were 79.5%, 60.1%, and 42.1%, respectively. Levels of serum AST and ALT were stable. CA-125 levels for both groups were also available.ConclusionBased on our analysis of a single institution’s series of patients with OCLM, RFA could be a feasibly effective option in the management of OCLM.

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Six versus nine cycles of paclitaxel-carboplatin as first-line chemotherapy in patients with newly diagnosed epithelial advanced ovarian cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16535 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16535-e16535

Author(s):

B. Nayl ◽

X. Durando ◽

C. Pomel ◽

P. Dubray ◽

M. Mouret-Reynier ◽

...

Keyword(s):

Ovarian Cancer ◽

Cytoreductive Surgery ◽

Median Overall Survival ◽

Progressive Disease ◽

Advanced Ovarian Cancer ◽

Stage Iiic ◽

Chemotherapeutic Regimen ◽

Platinum Based Chemotherapy ◽

Multimodality Approach ◽

Infusion Period

e16535 Background: A multimodality approach with cytoreductive surgery and six courses of paclitaxel-platinum-based chemotherapy is actually the mainstay of treatment of Advanced Ovarian Cancer (AOC). This study was performed to determine retrospectively the efficacy of three additional cycles of paclitaxel-carboplatin (PC) in patients with AOC who had previously demonstrated chemosensitivity to six courses of this regimen. Methods: From January 2000 to August 2008, 125 epithelial AOC (FIGO stages IIIC and IV) were diagnosed in a single institution. After a cytoreductive surgery, 51 patients received six cycles of PC (PC 6 group), 57 received 9 (PC 9 group), and 17 experienced progressive disease during treatment. The chemotherapeutic regimen consisted of intravenous paclitaxel 175 mg/m2 for a 3-hour infusion period and intravenous carboplatin AUC 5 every 3 weeks. Results: Median age was 62 years in PC6 group and 59.7 years in PC9. According to the FIGO criteria, 72.6% patients were in stage IIIC in group PC6 and 75.4% in group PC9. Except the patients who experienced refractory disease, complete clinical response at the end of chemotherapy was assessed in 71.4% patients in group PC6 and 71.9% in PC9 (p = 0.13). The median time to progression (TTP) was 26.2 months in PC6 and 29 months in PC9 (p = 0.5). The median overall survival (OS) was 106 months and 97 months respectively (p = 0.16). Conclusions: This retrospective study suggests that three cycles of consolidation chemotherapy with paclitaxel and carboplatin might not prolong duration of TTP or OS in AOC patients. No significant financial relationships to disclose.

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Ovarian metastasis from nongynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

Journal of Ovarian Research ◽

10.1186/s13048-020-00714-8 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Jing-Jing Zhang ◽

Dong-Yan Cao ◽

Jia-Xin Yang ◽

Keng Shen

Keyword(s):

Ovarian Cancer ◽

Adjuvant Treatment ◽

Cytoreductive Surgery ◽

Ovarian Metastasis ◽

Primary Site ◽

Prognostic Indicators ◽

Ca 125 ◽

College Hospital ◽

Primary Ovarian Cancer ◽

Postoperative Adjuvant Treatment

Abstract Background Metastasis to the ovary from nongynecologic organs accounts for 9% of all ovarian malignancies. Although the most common nongynecologic primary site of ovarian metastasis is the gastrointestinal tract, metastasis from other sites to the ovary is not uncommon. Differential diagnosis of primary and metastatic ovarian tumors is important; otherwise, appropriate treatment cannot be determined. Furthermore, an optimal treatment strategy for ovarian metastasis from nongynecologic primary sites still needs to be explored. Methods One hundred seventy-seven patients with ovarian metastasis from nongynecologic primary sites admitted to Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. Results The mean age was 48 years (range, 18–83). Approximately 60% of patients were premenopausal women. The two most common nongynecologic primary sites of ovarian metastasis were the colorectum (68 cases) and stomach (61 cases). In addition to the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), and ascites (27.7%), 18.1% of patients presented with abnormal uterine bleeding. Half of the patients who tested serum CA-125 preoperatively had elevated CA-125 levels within the range of 35 U/ml to 200 U/ml. More than 70% of synchronous ovarian metastases were preoperatively misdiagnosed as primary ovarian cancer. Of all included cases, 56.5% achieved optimal cytoreductive surgery (the diameter of the largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary site, optimal cytoreductive surgery, tumor differentiation, and postoperative adjuvant treatment were identified as prognostic indicators. Conclusions The colorectum and stomach are the most common nongynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easily misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be performed to confer survival benefit in selected patients.

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Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

Journal of Clinical Oncology ◽

10.1200/jco.2016.68.6907 ◽

2016 ◽

Vol 34 (28) ◽

pp. 3460-3473 ◽

Cited By ~ 150

Author(s):

Alexi A. Wright ◽

Kari Bohlke ◽

Deborah K. Armstrong ◽

Michael A. Bookman ◽

William A. Cliby ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Clinical Oncology ◽

Cytoreductive Surgery ◽

Gynecologic Oncology ◽

Phase Iii ◽

Stage Iiic ◽

American Society ◽

Interval Cytoreduction

Purpose To provide guidance to clinicians regarding the use of neoadjuvant chemotherapy and interval cytoreduction among women with stage IIIC or IV epithelial ovarian cancer. Methods The Society of Gynecologic Oncology and the American Society of Clinical Oncology convened an Expert Panel and conducted a systematic review of the literature. Results Four phase III clinical trials form the primary evidence base for the recommendations. The published studies suggest that for selected women with stage IIIC or IV epithelial ovarian cancer, neoadjuvant chemotherapy and interval cytoreduction are noninferior to primary cytoreduction and adjuvant chemotherapy with respect to overall and progression-free survival and are associated with less perioperative morbidity and mortality. Recommendations All women with suspected stage IIIC or IV invasive epithelial ovarian cancer should be evaluated by a gynecologic oncologist prior to initiation of therapy. The primary clinical evaluation should include a CT of the abdomen and pelvis, and chest imaging (CT preferred). Women with a high perioperative risk profile or a low likelihood of achieving cytoreduction to < 1 cm of residual disease (ideally to no visible disease) should receive neoadjuvant chemotherapy. Women who are fit for primary cytoreductive surgery, and with potentially resectable disease, may receive either neoadjuvant chemotherapy or primary cytoreductive surgery. However, primary cytoreductive surgery is preferred if there is a high likelihood of achieving cytoreduction to < 1 cm (ideally to no visible disease) with acceptable morbidity. Before neoadjuvant chemotherapy is delivered, all patients should have confirmation of an invasive ovarian, fallopian tube, or peritoneal cancer. Additional information is available at www.asco.org/NACT-ovarian-guideline and www.asco.org/guidelineswiki .

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