Cytoreduction For Epithelial Ovarian Cancer Research Articles

The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer

The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer

The utility of presurgical CA125 to predict optimal tumor cytoreduction of epithelial ovarian cancer

The objective of this study was to evaluate the ability of a preoperative serum CA125 to predict whether optimal debulking (OD) could be achieved for patients with stage III and IV epithelial ovarian cancer (EOC). The records of consecutive patients who underwent primary surgery for EOC at Indiana University Hospital between January 1997 and January 2003 were reviewed. Eligibility criteria included FIGO stage III/IV disease, surgery by gynecologic oncology faculty, preoperative CA125, and an operative note clearly defining volume of residual disease. The Medcalc software statistical package was used to generate a receiver-operating characteristic (ROC) curve. Two hundred and eighty-nine cases of stage III/IV EOC were identified, of which 164 met the eligibility criteria. Serum CA125 </=400 was associated with OD >/=75% of the time. Conversely, OD was achieved in </=40% of patients with CA125 >/=4500. The area under the ROC curve for CA125 was .670. The OD rate for those with and without ascites was 49% and 79%, respectively (P < 0.001). In a multivariate analysis using CA125, age, and ascites, the area under the curve was 0.686. We conclude that preoperative serum CA125 did not reliably predict OD in patients with stage III-IV EOC.

Bowel resection at the time of primary cytoreduction for epithelial ovarian cancer.

The purpose of this study was to determine the morbidity and survival associated with bowel resection at the time of primary cytoreductive surgery for ovarian cancer. We reviewed all patients undergoing bowel resection by gynecologic oncology faculty at the time of primary cytoreduction for advanced epithelial ovarian cancer diagnosed between 1983 and 1995. There were 105 patients meeting the above criteria. The median age was 65 years (range 34 to 85 years). There were 76 stage III and 25 stage IV cancers. The primary indication for bowel resection was tumor debulking in 92% of the patients. Seventy patients had segmental resection of the colon only, and 22 patients underwent resections that included the large and small bowels. Mean operating time was 260 minutes and mean estimated blood loss was 1,447 mL. Thirty-three (31%) patients were optimally cytoreduced to less than 1 cm residual disease. Ten patients experienced major complications directly related to bowel resection, including bowel fistula (4 patients), early postoperative bowel obstruction (5 patients), and stomal hernia (1 patient). Other morbidity included ileus for more than 10 days (18 patients), cardiac complications (17 patients), pneumonia (8 patients), sepsis (5 patients), and thromboembolism (4 patients). Six patients died and five patients required reexploration within 30 days of operation. Patients with preoperative bowel obstruction and suboptimal residual disease were more likely to have postoperative morbidity. Median survival in the optimally debulked patients was 35 months compared with 18 months in patients suboptimally cytoreduced (p = 0.006). Multivariate analysis demonstrated that optimal debulking (p = 0.009) and platinum chemotherapy (p = 0.00006) were independently associated with improved survival. Age, International Federation of Gynecologia Oncologists stage, American Society of Anesthesiologists class, and paclitaxel chemotherapy did not influence survival. In patients undergoing bowel resection at the time of primary cytoreduction for ovarian cancer, optimal cytoreduction to less than 1 cm residual disease results in improved survival. Morbidity is common but is comparable to other published series of ovarian cancer patients undergoing primary cytoreductive surgery without bowel resection. Additionally, patients with preoperative bowel obstruction and suboptimal residual disease are more likely to have serious morbidity.

Secondary Cytoreduction in Epithelial Ovarian Cancer

After completing this lesson, the participant will understand the controversies and possible indications for secondary surgery and debulking in the management of epithelial ovarian cancer.

Surgical staging and cytoreductive surgery of epithelial ovarian cancer

Surgery remains the cornerstone of the treatment for epithelial ovarian cancer. In early ovarian cancer, the initial operation is a complete assessment of the spread of disease. In this staging operation, 33% of patients thought to have either Stage I or II tumors will be found to have advanced-stage disease. The correct diagnosis of advanced disease prevents improper treatment of patients originally thought to have early disease. For patients with advanced disease, the initial cytoreductive operation reduces tumor bulk and produces increased sensitivity to chemotherapy for the remaining tumor. The principles of cellular kinetics provide good theoretic evidence for the benefit of cytoreductive surgery. Current studies relating to primary and secondary surgical cytoreduction of epithelial ovarian cancer were reviewed. Current indirect evidence indicates a significant survival benefit for patients with epithelial ovarian cancer who undergo successful surgical cytoreduction. Several recent studies also have shown the importance of the biology of the tumor, the extent of tumor spread, the location of the tumor, the cell type, the histologic grade, and the age of the patient. Although the literature contains fewer reports of secondary cytoreductive surgery than of primary cytoreductive surgery at the time of second-look, surgical reassessment appears to provide a survival benefit. The potential benefit of secondary cytoreduction will be increasingly important as new salvage therapies become available.

A randomized trial comparing whole abdominal radiotherapy with chemotherapy following cisplatinum cytoreduction in epithelial ovarian cancer. West midlands ovarian cancer group trial II

The potential role of consolidation therapy has been tested in a randomized trial in ovarian cancer. Patients were randomized to receive either whole abdominal radiotherapy using the moving strip technique (n = 56) or one year of chlorambucil (n = 53) following primary surgery, five courses of cisplatinum 100 mg/m2, and second look laparotomy. Overall survival at two years was 35%. There was no significant difference in survival between the two groups, and in spite of the observation that approximately 50% of the patients were optimally debulked prior to consolidation, no subgroups in either arm could be identified who might benefit from consolidation therapy. Toxicity was considerable in both arms, and almost 50% of patients were unable to complete the planned treatment in both arms. These results suggest that after primary surgery and cisplatinum chemotherapy, there is no indication for consolidation therapy with either radiotherapy or alkylating agents.