Patterns of relapse in patients treated with surgery followed by platinum based chemotherapy for advanced epithelial ovarian cancer

Abstract

16562 Background: Although relapse is common after treatment for ovarian cancer there have been few studies on patterns of relapse. We sought to determine the commonest site or sites of relapse and to determine the influence of stage, histology, grade and sites of residual surgical disease on relapse. Methods: Medical, surgical and radiological records from patients who had undergone primary or interval cytoreductive surgery followed by platinum based chemotherapy for epithelial ovarian cancer between 2001 and 2006 at the Hammersmith Hospital were retrospectively reviewed. Data was collected for sites of residual disease at surgery, chemotherapy response and location of sites of relapse. Results: 145 patients were identified of whom 100 were evaluable for inclusion in the study. 66% were optimally or totally debulked with 59% (59/100) achieving a complete response to treatment by radiological and clinical criteria. 52 patients (52%) relapsed: median time to relapse was 7.4 months. Patients who had been totally macroscopically debulked had longer time to relapse than those who had undergone optimal or suboptimal debulking (10.9 vs 7.1 and 6.4 months respectively). The majority (58%) of patients presented at relapse with abdominal symptoms. 25% of patients relapsed at a single site: commonest site being the pelvis, 38% patients relapsed at two sites; commonest sites the liver and peritoneum, 25% relapsed at 3 sites: commonest site: peritoneum and 13% of patients relapsed at 4 sites: commonest site lymph nodes. 50% of patients that had less than complete macroscopic debulk at initial surgery but subsequent complete response to chemotherapy relapsed at sites of residual surgical disease. 50% relapsed with new sites of disease; commonest site being the lymph nodes. Higher grade and stage tumours relapsed more frequently and had a reduced time to relapse. Conclusion: These results demonstrate that ovarian cancer more commonly relapses at multiple sites. The majority of patients relapse within 1 year and present with abdominal symptoms. The finding that patients relapse at sites of surgically inoperable disease (despite a subsequent response to chemotherapy) re-enforces the need for a more aggressive surgical approach in treating ovarian cancer. No significant financial relationships to disclose.