Role Of Secondary Cytoreduction Research Articles

The Role of Secondary Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in Recurrent Ovarian Peritoneal Carcinomatosis.

Ovarian cancer maintains the highest mortality rate among gynecological malignancies. Unfortunately, two-thirds of cases are diagnosed at an advanced stage with the presence of peritoneal carcinomatosis. In this study, we aimed to present the 7-year results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in cases where peritoneal carcinomatosis developed during the medical oncological treatment and follow-up after primary high-grade serous ovarian cancer debulking surgeries. Data from 63 patients collected prospectively in our clinic were retrospectively evaluated. Postoperative Clavien-Dindo grade 3-4 complications occurred in 12 cases (19%) and 14 cases (22.2%), respectively. CD grade 3a complications developed in four cases (6.3%), which were treated with percutaneous drainage catheters, while CD grade 3b complications occurred in eight cases (12.7%), and these cases underwent reoperation. Five cases (7.9%) experienced mortality within the first 30 days. The mean survival time was determined as 44.99 months (36.33-53.65), while the median survival time was 56 months. In selected patients requiring redo surgery due to recurrent ovarian cancer, secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are associated with longer overall survival and should be considered in the treatment of advanced-stage disease. Further large-scale randomized controlled trials are needed in this regard.

181MO Secondary cytoreduction in platinum-sensitive relapsed ovarian cancer: An individual patient level meta-analysis

The role of secondary cytoreduction in recurrent ovarian cancer has not been clearly defined. We aim to synthesize the efficacy of secondary cytoreduction in platinum-sensitive relapsed ovarian cancer patients.

Paraaortic and pelvic lymph node dissection in the combined treatment of recurrent ovarian cancer with isolated lymph node lesion: a literature review

The aim of the work is to analyze all available literature data on the role of secondary cytoreduction, its effectiveness and safety in the recurrence of ovarian cancer (ОС) with isolated lymph node (LN) lesion.The importance and place of secondary cytoreduction in the combined treatment of recurrent ОС is one of the most controversial topics. The lesion of the LN in recurrent Ос varies from 12 % to 37 %, but an isolated recurrence in the LN is a very rare occurrence, about 5 %. The most common localization in recurrent ОС with isolated LN lesion is the paraaortic LN.The results of this literature review suggest that isolated Ln lesion should be clearly distinguished from recurrence at other sites (such as peritoneal and parenchymal), since patients with isolated recurrence in the LN have a relatively indolent course of the disease. The frequency of complete cytoreduction according to the available data of retrospective studies reaches 100 %. Paraaortic and pelvic lymph node dissection without a macroscopically detectable residual tumor in combination with postoperative systemic chemotherapy leads to improved survival rates compared only with systemic drug treatment of patients with isolated LN lesion in recurrent ОС. median survival from the moment of relapse detection and overall survival varies from about 2.5 to 4 years and >5 years, respectively. Systemic paraaortic and pelvic lymph node dissection is preferable compared to selective lymphadenectomy, as it is accompanied by an increase in progression-free survival, although it doesn’t significantly prolong overall survival.

Phase 2 non-randomised trial of secondary cytoreduction and hyperthermic intraperitoneal chemotherapy in recurrent platinum-sensitive ovarian cancer.

BackgroundThe role of secondary cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) is not clearly defined in recurrent platinum-sensitive ovarian cancer (PSOC). There is a paucity of studies on secondary cytoreduction with HIPEC in PSOC from developing countries like India. This study was done to assess the feasibility and safety of secondary cytoreduction and HIPEC in recurrent PSOC.MethodsThis was a prospective, non-randomised, open-label, phase 2 trial of secondary cytoreduction and HIPEC (Cisplatin 75 mg/m2 43°C over 60 minutes) in patients with recurrent platinum-sensitive epithelial carcinoma of ovary/fallopian tube/peritoneum done in a tertiary cancer centre from February 2016 to August 2019. The primary outcome was to assess the overall survival (OS) and the secondary outcomes were to assess the progression-free survival (PFS) and toxicity.ResultsTwenty-seven patients were screened and among them, 15 patients were included in this analysis with a median follow-up of 25 months. The mean cancer antigen (CA) 125 at the time of recurrence was 149 U/mL (range: 10–2,030 U/mL) and the median platinum-free interval was 21 months. The perioperative chemotherapy used was paclitaxel + carboplatin 53.3% (8/15), liposomal doxorubicin + carboplatin 40% (6/15) and none 6.5% (1/15). The median Peritoneal Carcinomatosis Index score was 8 (range: 3–25). The Clavien Dindo score was I, II and III in 6.7%, 26.7% and 13.3% patients, respectively. Recurrence was radiological and biochemical in 60% (9/15) and 7% (1/15), respectively. The most common site of recurrence was intra-abdominal (peritoneal). The median PFS and OS were 15 months (range: 0–34) and 26 months (range: 23–29), respectively. The grade 3 or 4 toxicity was 40%.ConclusionSecondary cytoreduction with HIPEC is feasible and safe in recurrent PSOC. Conclusive evidence that secondary cytoreduction with HIPEC is essential awaits the results from ongoing randomised controlled trials.

The role of secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer: what do the trials tell us?

The role of secondary cytoreduction in recurrent, platinum-sensitive ovarian cancer: what do the trials tell us?

THE VALUE OF CYTOREDUCTIVE SURGERY FOR ISOLATED LYMPH NODE RECURRENCE OF OVARIAN CANCER

The purpose of the study was to undertake a systematic literature review regarding the role of cytoreductive surgery in treatment of recurrent ovarian cancer, as well as to summarize available data on various current studies and estimate indications for secondary cytoreduction in recurrent ovarian cancer with isolated lymph node involvement.Material and Methods. The search for relevant sources was carried out in PubMed, Gynecol Oncol, Medline, NCCN, Elibrary systems; publications were included from January 2006 up to March 2019. Of the 87 studies found, 26 were used to write a systematic review.Results. Ovarian cancer (OC) remains the leading cause of death from gynecological cancer. The initial treatment for IC-IV stages of OC includes surgical cytoreduction followed by platinum-containing chemotherapy. The best outcomes are observed in patients, in whom complete cytoreduction has been achieved. Despite this fact, most patients develop relapses and the 5-year survival rate is about 30 %. The frequency of lymph node involvement in patients with recurrent OC is not reliably known; isolated lymph node recurrence is reported to occur in 5–32 % of patients. To date, the problem regarding the extent of lymph node dissection in treatment of OC recurrence is still unsolved. In our paper we review the available data concerning the role of secondary cytoreductive surgery for isolated lymph node recurrence of ovarian cancer.Conclusion. Isolated lymph node recurrence of ovarian cancer may indicate a more favorable prognosis and has a less aggressive pattern of OC relapse. The role of secondary cytoreduction in this context is not fully understood, but this category of patients may be one of the most suitable for surgical treatment of ovarian cancer recurrence.

The role of secondary cytoreduction in low-grade serous ovarian cancer or peritoneal cancer

ObjectivesWe sought to determine the benefit of secondary cytoreductive surgery (SCRS) in patients with low-grade serous ovarian or peritoneal carcinoma, and whether cytoreduction to no gross residual disease affects survival. MethodsA single institution retrospective chart review was conducted in patients with recurrent low-grade serous carcinoma who underwent SCRS between 1995 and 2012. Data including demographics, survival, chemotherapy, disease characteristics at the time of surgery, residual disease, and operative complications were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Kaplan–Meier and log-rank tests were used to examine survival outcomes. ResultsForty-one patients met inclusion criteria. The median time between primary tumor debulking and SCRS was 33.2months. Of 41 eligible patients who underwent SCRS, 32 (78%) had gross residual disease at the completion of secondary surgery. The median PFS for patients with no gross residual disease after SCRS was 60.3months, compared to 10.7months for patients with gross residual disease (p=0.008). Median OS from diagnosis for patients with no gross residual disease after SCRS was 167.5months compared to 88.9months (p=0.10). Median OS from the time of SCRS for patients with no gross residual disease was 93.6months compared to 45.8months (p=0.04). Complications occurred in 61% of patients after SCRS; there were no deaths directly attributable to surgery. ConclusionOur results suggest a benefit to SCRS in patients with recurrent low-grade serous carcinoma. Efforts to maximally cytoreduce patients should be made as patients with no gross residual disease had a better PFS and a trend toward better OS.

The role of secondary cytoreduction in patients with recurrent low-grade serous ovarian carcinoma

The role of secondary cytoreduction in patients with recurrent low-grade serous ovarian carcinoma

Timing for starting second-line therapy in recurrent ovarian cancer

Ovarian cancer is the leading cause of gynecologic cancer-related death in Europe and the USA. The optimal treatment strategy for this malignancy includes accurate presurgical and surgical staging, optimal debulking surgery, and first-line therapy with platinum-based chemotherapy. Unfortunately, the majority of patients diagnosed with advanced ovarian cancer will eventually relapse and die. However, an appropriate management can have a major impact on survival: salvage chemotherapy can prolong survival in the majority of cases and, in selected patients, surgical cytoreduction of recurrent disease can be beneficial. The optimal timing for starting second-line therapy should be based on symptomatic or radiologic recurrence. In fact, even though cancer antigen 125 (CA 125) elevation significantly anticipates a clinical relapse, a randomized trial failed to show a survival advantage for starting second-line therapy on the basis of CA 125 elevation. This is the most solid evidence coming from a randomized trial; however, we must take into account some limitations: in this study the role of secondary cytoreduction was not considered and, at the time of study conduction, more active salvage drugs/regimens were not yet available. In the near future, a better knowledge of ovarian cancer biology, more sensitive diagnostic techniques, more accurate and less invasive surgical procedures along with the availability of new agents will further improve prognosis. In this scenario, the anticipation of salvage therapy will probably play a different role.

Secondary Debulking Including Nephrectomy in Recurrent Uterine Carcinosarcoma: A Case Report

The role of secondary cytoreduction in the treatment of recurrent uterine carcinosarcoma is controversial. This report explores the effectiveness of secondary debulking for an isolated recurrence. We report the case of a 59-year-old patient with recurrent uterine carcinosarcoma who underwent secondary debulking including nephrectomy. The patient is currently without evidence of disease 36 months after secondary debulking including nephrectomy, which was followed by salvage chemotherapy. The role of secondary cytoreduction in patients with isolated recurrence of uterine carcinosarcoma is poorly defined. This report suggests that patients might benefit from this aggressive approach in achieving complete cytoreduction.

Role of secondary cytoreduction in recurrent ovarian cancer

The majority of ovarian cancer patients will recur despite aggressive initial debulking surgery followed by platinum- and taxane-based chemotherapy. At present, there is no standard of care for management of these patients. Secondary cytoreductive surgery may be offered to patients with disease recurrence after a disease-free interval of 6–12 months, during which time they demonstrate a complete response to primary therapy and have no evidence of disease. The key is to be able to accurately predict preoperatively which patients have the greatest likelihood of being completely cytoreduced. Although the existing literature is limited, it does show a consistent survival benefit, specifically in patients undergoing maximal cytoreduction to no gross evidence of disease. This article discusses various selection criteria that have been demonstrated to be predictive of successful surgery, as well as various prognostic factors that influence survival following secondary cytoreductive surgery.

The role of secondary cytoreduction in the management of the first relapse in epithelial ovarian cancer

BackgroundThe aim of this study was to investigate the benefit of secondary cytoreduction (SCR) in the first relapse in epithelial ovarian cancer and to attempt to define selection criteria for SCR. Patients and methodsA retrospective population-based study on recorded information from 789 patients treated at the Norwegian Radium Hospital during 1985–2000 for their initial recurrence. In all, 217 had SCR and 572 were treated with chemotherapy alone. ResultsMedian survival time (MST) was 1.1 years for the chemotherapy group. Complete optimal cytoreduction (COC) was achieved in 35% of all 217 patients, in 49% of the patients operated with debulking intent and in 52% if bowel surgery was done with debulking intent. MST was 4.5 versus 0.7 years for 0 versus>2 cm residual disease, respectively. Residual disease after SCR, treatment-free interval (TFI) and age were found to be prognostic factors for overall survival (OS) in multivariate analysis. Localised tumour was found to be the only significant factor to predict COC. ConclusionsSCR followed by chemotherapy gives a clear survival benefit compared with chemotherapy and should be offered when the tumour is localised. The combination of COC, TFI >24 months and age ≤39 years identifies a group of patients with the best OS.

The current treatment of recurrent ovarian cancer

Contemporary management of recurrent ovarian, primary peritoneal, and fallopian tube cancers has continued to evolve and now offers women the hope of extended survival with an improved quality of life. Platinum continues to be the single most active agent in the treatment of ovarian cancer, but acquired resistance to platinum often emerges. Fortunately, a number of novel agents and treatment strategies have been developed to meet the goals of ameliorating symptoms while extending survival. Classically, patients have been treated based upon the interval from last platinum administration during front-line therapy until time of recurrence. This review focuses upon the current treatment strategies used for platinum-refractory, platinum-resistant, and platinum-sensitive patients. The incorporation of targeted biologic agents is also discussed, along with the role of secondary cytoreduction. It is hoped that the results of future and ongoing clinical trials will offer further advances in the treatment of this devastating disease.

Secondary cytoreduction and post-operative second line chemotherapy with gemcitabine & cisplatin in recurrent epithelial ovarian cancer

5161 Background: The role of secondary cytoreduction in recurrent epithelial ovarian cancer is not clearly defined. This study was designed to evaluate the efficacy of secondary cytoreduction and post operative 2nd line chemotherapy with gemcitabine and cisplatin in recurrent ovarian cancer. Methods: Patients who had undergone primary cytoreductive surgery, had received chemotherapy and showed a complete response but have developed subsequent recurrence were included. Evidence of measurable disease on imaging study was required. Abdomen was opened with a vertical incision, ascitic fluid/washings were removed, maximal cytoreduction was done to resect the tumor to <1 cm diameter. All patients were given gemcitabine 1250 mg /m2 on day 1 and 8 and cisplatin 70 mg/m2 on day 8 only. Cycles were repeated every three weeks. RECIST was used for response evaluation. Results: Forty-two patients were enrolled from Dec 98-Jun 03. Median age was 52 years (range 40 -68). Thirty-two had previously received cyclophosphamide and cisplatin while 10 had received paclitaxel and cisplatin. The disease free interval was more then 6 months in 28 patients and less then 6 months in 14. Optimal cytoreduction was achieved in 16(38.1%) only. Gut injury was seen in 3(7.1%) and bladder perforation in 4(9.5%). Among 16 patients with optimal cytoreduction, 6 had a CR while 10 showed a PR with chemotherapy whereas in patients with sub-optimal surgery CR was seen in 4 patients, PR in 16 and NR in 6. All patients who had a CR previously had DFI >6 months. Eight patients are still alive at a median follow up of 16 months (range 6–42 months). Conclusion: Secondary cytoreduction and postoperative second line chemotherapy with gemcitabine and cisplatin is a reasonable treatment option for patients with recurrent epithelial ovarian cancer who present after a disease free interval of more then 6 months. No significant financial relationships to disclose.

Recurrent immature teratoma of the ovary: a case report of radical secondary cytoreduction with replacement of the aortic bifurcation

Background Composing of less than 1% of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. Although standard treatment protocol for primary disease has improved over the past decades, the role of secondary cytoreduction in the setting of recurrence remains controversial. Case A 20-year-old Chinese female presented with recurrent immature teratoma at the level of the aortic bifurcation. Patient was status post a right salpingo-oophorectomy at time of her initial diagnosis 8 years ago, and subsequent exploratory laparotomies and chemotherapy when recurrence that developed at the before-mentioned site. She ultimately underwent a radical cytoreduction with en-block excision of the aortic mass and simultaneous artificial aortic bifurcation graft. Conclusion There may be a beneficial role of radical secondary cytoreduction in the setting of recurrent immature teratoma.