Abstract
Despite optimal treatment (complete cytoreduction and adjuvant chemotherapy), 5-year survival for advanced ovarian cancer is approximately 30% and most patients succumb to their disease. Cytoreductive surgery is accepted as a major treatment of primary ovarian cancer but its role in recurrent disease is controversial and remains a field of discussion mainly owing to missing data from prospective randomized trials. A critical review of literature evidence on secondary surgery in recurrent ovarian cancer will be described.
Highlights
Despite optimal treatment, 5-year survival for advanced ovarian cancer is approximately 30% [1] and most patients succumb to their disease
Cytoreductive surgery is accepted as a major treatment of primary ovarian cancer but its role in recurrent disease is controversial and remains a field of discussion mainly owing to missing data from prospective randomized trials and to the broad variety of definitions of surgical procedures
The recently published MRC OVO5/EORTC 55955 trial [4] concluded that early intervention with chemotherapy for recurrent ovarian cancer detected only on the basis of serum CA 125 rising does not alter overall survival with respect to waiting for the appearance of symptomatic disease, Tanner et al [5] found that survival after ovarian cancer recurrence was greater in asymptomatic patients than in those with symptoms (45 versus 29.4 months, P = 0.006), and this was due to the rate of successful secondary cytoreductive surgery which was higher in the asymptomatic group (90% versus 57%, P = 0.053)
Summary
Despite optimal treatment (complete cytoreduction and adjuvant platinum-paclitaxel chemotherapy), 5-year survival for advanced ovarian cancer is approximately 30% [1] and most patients succumb to their disease. The recently published MRC OVO5/EORTC 55955 trial [4] concluded that early intervention with chemotherapy for recurrent ovarian cancer detected only on the basis of serum CA 125 rising does not alter overall survival with respect to waiting for the appearance of symptomatic disease, Tanner et al [5] found that survival after ovarian cancer recurrence was greater in asymptomatic patients than in those with symptoms (45 versus 29.4 months, P = 0.006), and this was due to the rate of successful secondary cytoreductive surgery which was higher in the asymptomatic group (90% versus 57%, P = 0.053). Secondary cytoreductive surgery for recurrent ovarian cancer is defined as an operative procedure performed at some time remote (generally disease free interval of more than 6 months) from the completion of primary therapy with the intended purpose of tumor reduction. The only 2 studies looking at secondary cytoreduction in patients with suboptimal response to primary treatment showed a marginal benefit of surgery at the cost of high morbidity (24%) and limited long-term benefit with a median survival of 9 months [6, 22] so, at present, there is no evidence that secondary surgery is of significant benefit in this population
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