PRO: Secondary Surgical Debulking is an Acceptable Option in Patients With Recurrent Platinum-Sensitive Ovarian Cancer

Abstract

Introduction While cytoreductive surgery and platinum-based chemotherapy remain mainstays of the primary treatment of epithelial ovarian cancer, 60% of patients will be diagnosed with a recurrence. Depite the large number of patients who experience recurrences, the econdary treatment of choice varies widely. Secondary cytoreductive surgery (SCR) in platinum-sensitive disase is a viable option for the treatment of recurrent epithelial ovarian ancer. The theory behind this technique stems from the same ratioale as that behind primary debulking procedures as developed by riffiths in 1975. It was hypothesized that by decreasing the tumor burden, the growth fractions of the tumor should increase. In doing this, tumor cells that are poorly perfused secondary to a large tumor size should be reduced. This leads to increased accessibility of the remaining tumor cells to chemotherapy delivered via the blood stream. Finally, by decreasing tumor burden, the chance that these ells would then undergo spontaneous mutation ending in drug-resisant strains should also decrease. This theory, along with the evidence that will be presented, justifies that a second debulking procedure, in the appropriate candidate, is an attractive option in the treatment of recurrent epithelial ovarian cancer in platinum-sensitive disease.