Salvage cytoreduction for chemorefractory ovarian cancer with peritoneal carcinomatosis: A last chance or futile efforts?

Abstract

The role of secondary cytoreductive surgery in recurrent ovarian cancer in the presence of carcinomatosis is increasingly accepted as being an effective management strategy for selected patients. However, in patients with chemorefractory disease, the role of cytoreduction remains controversial. The objective of this study was to evaluate if cytoreduction of peritoneal carcinomatosis in patients with chemorefractory recurrent ovarian cancer as salvage treatment confers any survival benefits. A retrospective review was performed on patients with chemorefractory ovarian cancer with peritoneal carcinomatosis who underwent cytoreduction as a salvage treatment. Survival was calculated using the Kaplan-Meier method. Univariate analysis was performed to examine potential prognostic factors using the log-rank test. A total of 16 patients were identified, of which 15 patients (94%) had FIGO Stage III ovarian cancer at initial diagnosis. The initial surgical effort was optimal in one patient (6%), and 13 patients (62%) had been on at least two lines of chemotherapy. The median progression-free and overall survival was 18 (95% CI 0-42) months and 36 (95% CI 14-58) months, respectively. The 1-, 3-year survival rate was 73% and 23%, respectively. ECOG status zero (P = 0.023) and younger patients (age < 51) (P = 0.066) appeared to be associated with an improved overall survival. Salvage cytoreduction may be considered a last chance effort to prolong survival in this group of patients with chemorefractory ovarian cancer who have a 'poor prognosis' and would otherwise not have been candidates for any proven or effective therapy.