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

Abstract

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.