Abstract
Few retrospective studies have shown a benefit in selected patients affected by heavily pre-treated, platinum-resistant ovarian carcinomas (PROCs) who have undergone cytoreduction at relapse. However, the role of tertiary and quaternary cytoreductive surgery is not fully defined. Our aim was to evaluate survival and surgical morbidity and mortality after maximal cytoreduction in this setting. We evaluated all consecutive patients undergoing cytoreduction for platinum-resistance over an 8-year period (2010–2018) in two different centers. Fifty patients (median age 52.5 years, range 34–75) were included; the median number of previous chemotherapy lines was three (range 1–7) and the median number of previous surgeries was one (range 1–4). Completeness of cytoreduction (CC = 0) was achieved in 22 patients (44%). Rates of major operative morbidity and 30-day mortality were 38% and 8%, respectively. Median follow-up was 35 months. The absence of tumor residual (CC = 0) was associated with a significantly better overall survival (OS) compared to the CC > 0 subgroup (median OS 32.9 months (95% CI 21.6–44.2) vs. 4.8 months (95% CI n.a.–9.8), hazard ratio (HR) 4.21 (95% CI 2.07–8.60), p < 0.001). Optimal cytoreduction is feasible and associated with promising OS in selected, heavily pre-treated PROCs. Further prospective studies are required to better define the role of surgery in platinum-resistant disease.
Highlights
Ovarian cancer (OC) is the leading cause of death from gynecological malignances with an estimated 21,750 new cases and 13,940 deaths in 2020 in the USA [1].Optimal surgical cytoreduction preceded and/or followed by platinum-based chemotherapy is currently the standard of care for advanced OC [2] and the absence of residual disease (CompletenessCancers 2020, 12, 2239; doi:10.3390/cancers12082239 www.mdpi.com/journal/cancersCancers 2020, 12, 2239 of cytoreduction [CC = 0]) at primary surgery has yet demonstrated to be the most relevant prognostic factor for overall survival (OS) [2,3,4]
We aimed to describe the characteristics and outcomes of heavily pre-treated platinum-resistant ovarian carcinomas (PROCs)
We report the surgical procedures and outcomes including morbidity and mortality
Summary
Optimal surgical cytoreduction preceded and/or followed by platinum-based chemotherapy is currently the standard of care for advanced OC [2] and the absence of residual disease In the context of platinum-sensitive disease, two phase III randomized controlled trials, the DESKTOP III [6,7] and the Gynecologic Oncology Group (GOG) 213 studies [8,9], analyzed the therapeutic impact of secondary cytoreductive surgery (SCS). The final results of the DESKTOP III trial showed that SCS in patients with a positive Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score (defined as complete resection at first surgery, good performance status (PS) and the absence of ascites) resulted in a median progression-free survival (PFS)benefit of 5.6 months
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