Do patients with recurrent ovarian cancer benefit from relative tumor reduction? Results from a prospective study

Abstract

e16541 Background: Primary cytoreduction is the cornerstone in the management of epithelial ovarian cancer (OC). However, the roles of salvage surgery and of tumor reduction are still discussed controversially. The present study was conducted to assess the impact of secondary tumor reduction surgery on progression-free survival and on overall survival. Methods: Between September 2000 and April 2006, 177 consecutive patients (pts) with a first relapse of OC underwent secondary tumor reduction surgery at our department. The achieved tumor reduction was categorized as 1/5 (20% tumor debulked), 2/5 (40%), 3/5 (60%), 4/5 (80%), or 5/5 (macroscopic tumor-free) and the maximal tumor diameter was also denoted (tumor free, < 1cm, ≥ 1cm). Results: The median age was 56 years (95% CI: 23–83), median follow-up was 10.8 months (95% CI: 1–65). In 79 pts (44.6%) complete macroscopic tumor resection was achieved (median overall survival (OAS) 60.6 months, 21.3–99.8 and median progression-free survival (PFS) 14.9 months, 11.7–18, p < 0.001). In 56 pts (31.6%) 4/5 of the tumor was removed (OAS 15.6 months, 10.3–20.8 and PFS 9 months, 7.2–10.7, p < 0.001), in 13 (7.3%) 3/5 (OAS 21.7 months, no interval and PFS 12 months, 0.0–24.5, p < 0.001) and in 7 (4%) each 2/5 tumor reduction (OAS was 14.2 months, 4.1–24.2 and PFS 11 months, 5.9–16, p < 0.001) and if 1/5 tumor reduction was achieved OAS was 11.1 months, 2–20.1 and PFS 7 months, 2.5–11.4, p < 0.001. Fifteen pts (8.5%) had a bulky unresected disease (OAS 4.7 months, 1.0–8.3 and PFS of 3.7 months, 0–7.6, p < 0.001). From these 98 (55.4%) pts without complete macroscopic tumor resection, 46 were left with <1cm tumor diameter (OAS 17.2 months, 13–21.4 and PFS 9 months, 7.4–10.6 p < 0.001) and 52 with ≥1cm tumor diameter (OAS 8.7 months, 4.2–13.2 and PFS 7 months, 5.8–8.2 p < 0.001). All in all, the median postoperative survival for pts with tumor residuals and any tumor reduction (4/5, 3/5, 2/5. and 1/5 tumor reduction) were better when compared to pts with no tumor reduction (24.8 months vs. 4.7, p < 0.001). Conclusions: Our data demonstrate a significant benefit for salvage surgery if a macroscopic complete tumor resection can be achieved. We could not see any effect of relative tumor reduction on PFS or OAS. No significant financial relationships to disclose.