In Reply: Response to Sammartino et al.

Abstract

Dear colleagues,We would like to thank you for your fruitful comments onour article. You expressed strong concerns regarding favor-ing systemic therapy only in patients with supposed resect-able tumors. We share your concerns; however, we have toadmit that surgery may offer benefit but will not solve allproblems in these patients. First, it is unlikely that patientswill be cured by surgery for recurrent ovarian cancer. Sec-ond, cytoreductive surgery always includes a non-negligiblerate of complications. Therefore, we believe that an invasiveapproach,especiallyifappliedinapalliativesetting,shouldbebased on strong evidence (e.g. randomized trials). So far,several randomized trials in patients with recurrent ovariancancer have only focused on systemic treatment and set stan-dards. In contrast, there isn’t any randomized trial evaluatingthe role of secondary cytoreductive surgery. The only evi-dence so far is based on retrospective series, mostly withoutany or with only historical controls. The positive resultsreported after secondary surgery might be attributable to aselection process of good prognostic patients—perhapspatients who would have had a similar good prognosis afterchemotherapy only. Having said this, we agree that bothstandpoints are based on weak evidence and may be biasedby our own preferences. Therefore, a randomized trial isurgently needed to overcome the dark ages of speculation,andscientificallyevaluatethepotentialprognosticbenefitofsurgery against peri-operative morbidity and mortality [1].