Secondary Cytoreduction Research Articles

Minimal access surgery compared with laparotomy for secondary cytoreduction in patients with recurrent ovarian carcinomas

Minimal access surgery compared with laparotomy for secondary cytoreduction in patients with recurrent ovarian carcinomas

Bevacizumab after bevacizumab in platinum-sensitive recurrent ovarian cancer: A subgroup analysis of GOG0213.

5523Background: In GOG 213, a phase III randomized trial designed to determine the impact of secondary cytoreduction and/or incorporation of anti-angiogenesis therapy on overall survival (OS) in re...

Pancreatic resections as part of debulking surgery for relapsed epithelial ovarian cancer – a single center experience

Aims: To demonstrate the effectiveness and safety of pancreatic resections as part of cytoreductive surgery for relapsed epithelial ovarian cancer. Material and methods: Data of patients submitted to cytoreductive surgery for relpaed epithelial ovarian cancer in “Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute between January 2002 and May 2015 were retrospectively reviewed. Results: Five patients were considered eligible for the study. In four cases distal pancreatectomy was performed as part of secondary cytoreduction while in the fifth case a spleno-pancreatectomy was performed at the moment of tertiary cytoreduction. Postoperatively a single patient developed a pancreatic leak which was successfully managed in a conservative manner. A median overall survival of 36 months was reported after secondary cytoreduction while the patient submitted to pancreatic resection as part of tertiary cytoreductive surgery experienced a 10 months survival, the patient being dead of disease at the time of ending the study. Conclusions: Pancreatic resections can be safely introduced as part of the therapeutic armamentarium for relapsed epithelial ovarian cancer.

Liver resection as part of secondary cytoreduction in recurrent epithelial ovarian cancer

Liver resection as part of secondary cytoreduction in recurrent epithelial ovarian cancer

Clinicopathologic features of epithelial ovarian cancer

Objectives: This retrospective study was conducted at the Clinical Oncology Department of Mayo Hospital with the objectives to find out the frequency of different clinicopathologic features and to see the pattern of treatment and its outcome. Patients and methods: From 2000 to 2004, 375 patients were seen at the Department of Clinical Oncology, Mayo hospital, Lahore. A proforma was designed to document the age, parity, histopathology, stage, grade, clinical features, and family history. The information was obtained from the medical record section. Stage was assigned according to FIGO staging system. All patients with histopathologically proven epithelial ovarian cancer were included. Results: Epithelial ovarian cancer constituted 8.4 % of all female cancers. The median age at presentation was 51 years (range, 21-75 years). All patients were symptomatic before the diagnosis, with ascites being the most common single manifestation (38.4 %) and in patients with multiple signs and symptoms abdominal sym ptoms were most commonly seen (71.5 %). Median pre operative CA125 level was 218 U/ml. ).Optimal cytoreduction was seen in 36.5 % only, and 63.5% patients presented after sub-optimal cytoreduction. Majority of the patients (82.7%) presented in late stages (III & IV) and only 17.3 % in early stages (I&II). Most common histopathologic type of invasive cancer was serous cystadenocarcinoma , seen in 247(72.4%) patients. Endometrioid tumors were seen in very few (3.8 % ).High grade tumors were the most common. Most women were multiparous and only 16.5% were nulliparous. Post operative treatment primarily included cisplatin based combination chemotherapy. One hundred and twenty seven patients were re treated for recurrent or residual disease and 68 were referred for secondary cytoreduction and were given second line therapy subsequently. Conclusion: Epithelial ovarian cancer is not a silent disease, most patients are symptomatic and present in an advanced stage. In majority of the patients optimal cytoreduction is not achieved. Cystadenocarcinoma is the predominant histology and the endometrioid variety is seen only in few.

Case 2 – Trabectedin as a maintenance therapy in a patient with recurrent ovarian cancer and BRCA1 germline mutation

Treatment of patients with recurrent ovarian cancer (ROC) is complex. This case report describes the effects of a sequence of treatments in a BRCA1 mutation carrier with serous papillary poorly differentiated, platinumsensitive ROC. This consisted in primary surgery, adjuvant chemotherapy, secondary cytoreduction with Heated IntraPEritoneal Chemotherapy (HIPEC), 12 cycles of trabectedin in combination with pegylated liposomal doxorubicin (PLD) and 12 cycles of trabectedin alone, leading to complete radiological and biochemical response.

Performance of AGO score for secondary cytoreduction in a high-volume U.S. center

ObjectivesDetermine the predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score, and prognostic factors for survival, in patients undergoing secondary cytoreductive surgery (SCS) for recurrent ovarian cancer in a high-volume U.S. center. MethodsMedical records of women undergoing SCS between 12/1/1998 and 12/31/2013 were reviewed. Women with no gross residual disease (RD0) at primary surgery, ECOG performance status (PS) ≤1 at recurrence, and no ascites on CT at recurrence were classified as AGO score positive. Women with incomplete information to determine the AGO score were excluded. Overall survival (OS) and progression-free survival (PFS) following SCS, respectively, were estimated from multivariable Cox proportional hazards models. Results192 women met inclusion criteria. Median disease-free interval (DFI) was 1.9years (IQR, 1.0–3.5). Of the 102 (53.1%) AGO score positive cases, 84.3% (95% CI, 77.3–91.4%) achieved RD0 at SCS. However, 64.4% of AGO score negative cases also reached RD0. Patients with RD0 after SCS survived longer (median OS, 5.4years) vs. RD ≤1cm (2.4years) vs. RD >1cm (1.3years) (p<0.001). Median PFS was also longer in patients with RD0 (1.5years) vs. RD ≤1cm (0.9years) vs. RD >1cm (1.0years) (p=0.001). Among those with RD0 at SCS, AGO score was not associated with survival benefit, however, number of disease sites at recurrence, ECOG PS at recurrence, and DFI were associated with OS and PFS. ConclusionsAGO score can identify patients with a high likelihood of complete secondary cytoreduction and improved survival. However, most AGO score negative cases were also completed resected at SCS. Additional refinement of the score is needed to exclude women from SCS.

Laparoscopic Splenectomy for Secondary Cytoreduction in Ovarian Cancer Patients With Localized Spleen Recurrence: Feasibility and Technique

Study ObjectiveTo investigate the feasibility of laparoscopic splenectomy in patients with recurrent ovarian cancer with isolated spleen metastasis. Design(Canadian Task Force classification III). SettingTertiary referral centre in Rome, Italy. PatientsEight women with an isolated platinum-sensitive splenic relapse of ovarian cancer. InterventionBetween February 2013 and May 2015, 8 women with an isolated platinum-sensitive splenic relapse of ovarian cancer were submitted to laparoscopic splenectomy. Measurements and Main ResultsAll patients underwent laparoscopic splenectomy without conversion to an open approach. The median estimated intraoperative blood loss was 100 mL (range, 50–200 mL). The median operating room time was 200 minutes (range, 80–275 mL). No intraoperative complication occurred, and no intraoperative blood transfusions were required. The median length of hospital stay was 3 days (range, 2–5 days). Complete tumor resection was achieved in all patients. The median interval from surgery to adjuvant chemotherapy was 16 days (range, 14–24 days). After a median follow-up of 23 months (range, 6–32 months), no secondary recurrence or death of disease has been observed. ConclusionOur findings indicate that a laparoscopic approach for spleen removal is feasible in selected patients with a splenic relapse of ovarian cancer when performed in a tertiary referral center by a well-trained surgeon.

Feasibility of laparoscopic cytoreduction in patients with localized recurrent epithelial ovarian cancer.

ObjectiveTo assess the feasibility of laparoscopic cytoreduction in patients with localized recurrent epithelial ovarian cancer (EOC) by comparing its outcomes to those of laparotomy.MethodsWe performed retrospective analysis in 79 EOC patients who had a localized single recurrent site, as demonstrated by computed tomography (CT) scan, magnetic resonance imaging, or positron emission tomography/CT scan; had no ascites; were disease-free for 12 or more months prior; and who had undergone secondary cytoreduction (laparoscopy in 31 patients, laparotomy in 48 patients) at Samsung Medical Center between 2002 and 2013. By reviewing the electronic medical records, we investigated the patients’ baseline characteristics, surgical characteristics, and surgical outcomes.ResultsThere were no statistically significant differences between laparoscopy and laparotomy patients in terms of age, body mass index, cancer antigen 125 level, tumor type, initial stage, grade, recurrence site, type of procedures used in the secondary cytoreduction, adjuvant chemotherapy, and disease-free interval from the previous treatment. With regards to surgical outcomes, reduced operating time, shorter hospital stay, and less estimated blood loss were achieved in the laparoscopy group. Complete debulking was achieved in all cases in the laparoscopy group.ConclusionThe laparoscopic approach is feasible without compromising morbidity and survival in selected groups of patients with recurrent EOC. The laparoscopic approach can be a possible treatment option for recurrent EOC.

Long-Term Survival for Platinum-Sensitive Recurrent Ovarian Cancer Patients Treated with Secondary Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC).

To analyze the 5- and 7-year survival outcomes for women with platinum-sensitive recurrent epithelial ovarian cancer (REOC) who underwent secondary cytoreductive surgery (SCS) plus platinum-based hyperthermic intraperitoneal chemotherapy (HIPEC). From the electronic databases of the Department of Obstetrics and Gynecology at the Catholic University of the Sacred Heart of Rome and of the S. Orsola Hospital, University of Bologna, a consecutive series of REOC patients were selected using the following inclusion criteria: primary platinum-free interval (PFI-1) of 6months or longer, completeness of secondary cytoreduction score (CC) of 1 or lower, minimum follow-up period of 48months, Eastern Cooperative Group (ECOG) performance status at recurrence of 1 or less, and platinum-based HIPEC. Progression-free survival (PFS) and post-relapse survival (PRS) were calculated as the time between SCS+HIPEC and secondary recurrence or death, respectively. The final study population included 70 women with platinum-sensitive REOC. The median follow-up time was 73months (range 48-128months), and the median PFI-1 was 19months (range 6-100months). At the time of recurrence, the median peritoneal cancer index was 7 (range 1-21), and a CC score of 0 was achieved for 62 patients (88.6%). As the HIPEC drug, we used oxaliplatin in 17 cases (38.6%) and cisplatin in 43 cases (61.4%). No postoperative deaths were observed, and the complication rate for grades 3 and 4 disease was 8.6%. The median PFS duration was 27months (range 5-104months), and the 5- and 7-year PRS rates were respectively 52.8 and 44.7%, (median PRS 63months). The current study demonstrated favorable 5- and 7-year PRS rates for platinum-sensitive REOC patients undergoing SCS+HIPEC, which encourages the inclusion of patients in randomized clinical trials for definitive conclusions to be drawn.

Robotic Excision of Diaphragm Metastases With Liver Involvement

Advanced stage ovarian cancer is accompanied by metastases to the diaphragm in up to 40% of patients. Disease in this area is often cited as a reason for inability to achieve optimal cytoreduction. While reports have described both the safety and feasibility of secondary cytoreduction, including resection of the diaphragm, these primarily focus on an approach via laparotomy.

Complications of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Advanced Ovarian Malignancies: First Indian Study

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) has been proposed as a treatment for advanced ovarian carcinoma and pseudomyxoma peritonii. We analyzed the perioperative complications of extensive CRS + HIPEC in Indian patients with advanced ovarian malignancies and pseudomyxoma peritonii. In this prospective observational study, we included 38 patients from February 2013 to June 2015 with advanced EOC and pseudomyxoma peritonii treated by a dedicated peritoneal malignant disease treatment team in a tertiary care hospital. All patients underwent extensive CRS + HIPEC. The post-operative morbidity and mortality were analyzed. Our patients were grouped into frontline 21.1 % (n = 8), interval cytoreduction 50 % (n = 19), and secondary cytoreduction 28.9 % (n = 11) based on the timeline at presentation. Mean peritoneal carcinomatosis index (PCI) was 8.5 ± 7.45 (range 3–36). Average surgery duration was 9 ± 2.7 h (range 5.5–19). Mean perfusion temperature used was (42 ± 0.49 °C). Patients with PCI score ≥15 had prolonged gastrointestinal recovery (p = 0.043), post-operative ventilator need (p = 0.011), acute respiratory distress syndrome (ARDS) (p = 0.014), and dyspnea (p = 0.002) with trend towards adverse events. Closed method HIPEC was associated with prolonged hospital stay (p = 0.011), wound-related complications (p = 0.006), and ARDS (p < 0.001). Multivisceral resections were associated with increased ventilator need (p < 0.001), ARDS (p = 0.010), and adverse events (p = 0.044). The recurrent ovarian carcinomas were associated with more wound-related complications (p = 0.016). More adverse events with cisplatin 100 mg/m2 (p = 0.03) were dyselectrolytemia, acute renal failure, and fall in hemoglobin. No 30-day mortality was present. After a median follow-up of 17 (3–28) months, 15.8 % patients (n = 6) had recurrences and 5.3 % (n = 2) succumbed to disease. Ovarian peritoneal malignancies known for peritoneal recurrences are amenable for extensive cytoreduction and HIPEC with acceptable morbidity in Indian patients. A dedicated team of surgeon, anesthetist, medical oncologist, and intensivist is mandatory for better outcome.

Performance of AGO score for secondary cytoreduction in a high volume U.S. Center

Objectives: Determine the predictive value of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) score for secondary cytoreduction in recurrent epithelial ovarian cancer (EOC) in an independent, high-volume U.S. center.

Survival Impact of Secondary Cytoreductive Surgery for Recurrent Ovarian Cancer in an Asian Population.

The aim of this study was to evaluate the role of secondary cytoreductive surgery in Asian patients with recurrent ovarian cancer and to assess prognostic variables on overall post-recurrence survival time. We conducted a retrospective review of patients with recurrent ovarian cancer who underwent secondary cytoreduction at the Gynaecological Cancer Center at the KK Women's and Children's Hospital, Singapore, between 1999 and 2009. Eligible patients included those who had been firstly treated by primary cytoreductive surgery and followed by adjuvant chemotherapy and had a period of clinical remission of at least six months and subsequently underwent secondary cytoreductive surgery for recurrence. Univariate analysis was performed to evaluate various variables influencing the overall survival. Twenty-five patients met our eligibility criteria. The median age was 52 years (range=31-78 years). The median time from completion of primary treatment to recurrence was 25.1 months (range=6.4-83.4). Secondary cytoreduction was optimal in 20 of 25 patients (80%). The median follow-up duration was 38.9 months (range=17.8-72.4) and median overall survival time was 33.1 months (95% confidence interval, 15.3-undefined.). Ten (40.0%) patients required bowel resection, but no end colostomy was performed. One (4.0%) patient had wedge resection of the liver, one (4.0%) had a distal pancreatectomy, one (4.0%) had a unilateral nephrectomy, and one (4.0%) had adrenalectomy. There were no operative deaths. The overall survival of patients who responded to secondary cytoreductive surgery and adjuvant chemotherapy was significantly longer than those patients who did not respond to the treatment. Of those patients who responded to the surgical management, patients with clear cell carcinoma fared well compared to those with the endometrioid, mucinous adenocarcinoma, and papillary serous type (p<0.001). Complete secondary cytoreductive surgery appeared to have some relationship to overall survival but was not statistically significant. In carefully selected patients with recurrent ovarian cancer, optimal cytoreductive surgery is possible and in a subgroup of patients who respond to surgery and chemotherapy survival is significantly longer.

Liver resection for ovarian cancer liver metastases as part of cytoreductive surgery is safe and may bring survival benefit.

BackgroundThe aim of this study was to evaluate whether hepatic resections of ovarian cancer liver metastases provide a benefit in terms of survival as part of primary, secondary, tertiary, and even quaternary cytoreductive surgery.MethodsData of patients submitted to surgery for ovarian cancer liver metastases at Fundeni Clinical Institute between January 2002 and April 2014 were retrospectively reviewed. Liver lesions were classified according to their origin in parenchymal and peritoneal lesions.ResultsA total of 31 patients were identified: 11 of them underwent liver resection as part of primary cytoreduction, 15 at secondary cytoreduction, 3 at tertiary cytoreduction, and 2 at the time of quaternary cytoreduction. The survival of patients with primary cytoreduction including liver resection was significantly higher compared with that of patients with secondary cytoreductive surgery including liver resection (15.63 versus 6.63 months, log-rank p = 0.057, 90 % CI). The median survival of patients with hepatectomy for liver metastases from peritoneal seeding was higher than that of patients with hepatectomy for liver metastases from hematogenous origin (16.08 versus 12.66 months, log-rank p = 0.523).ConclusionsHepatectomy in ovarian cancer liver metastases is a safe and effective procedure; however, a benefit in terms of survival in favor of peritoneal seeding has been systematically observed.

Immature teratoma of ovary – outcome following primary and secondary surgery: study of a single institution cohort

ObjectiveTo analyse the clinical presentation, treatment – primary and secondary debulking and outcomes with focus on recurrences in ovarian immature teratoma. Study designThis is a single institution, retrospective analysis of 24 women who presented to a gynecologic oncology unit from 1999 to 2011 with ovarian immature teratoma. Patient's clinical presentation, operative and chemotherapy details were included in a database. Follow up details regarding recurrence and management and future outcomes were also noted. Overall survival was calculated from the date of registration to last follow up or date of death. Survival curve was constructed by Kaplan–Meier method. ResultsImmature teratoma accounted for 11% of 218 malignant germ cell tumors. Of the 24 patients, pain was the predominant symptom and abdominal mass was the commonest clinical presentation. Sixteen out of 24 patients presented in Stage I and grade 3 tumors were found in 43% of patients. Six patients had only unilateral salpingo oophorectomy and no staging procedure. Twelve patients underwent staging, with omentectomy being the commonest procedure. All but one, had cisplatin based combination chemotherapy. Six patients underwent secondary debulking of recurrence. Most recurrences were recorded in Stage III, higher grade tumors. With secondary cytoreduction and platinum based chemotherapy, it was possible to salvage most recurrences as well. Overall survival after a mean follow-up of 39 months was 91.6%. ConclusionMajority of the patients did well with conservative surgery in terms of survival, menstrual and reproductive function. Platinum based chemotherapy was indicated in higher grade and higher stage tumors as recurrences commonly occurred in this subgroup of patients. Recurrences could be salvaged with selected secondary cytoreduction and platinum based chemotherapy.

Randomized phase III trial of carboplatin/paclitaxel alone (CP) or in combination with bevacizumab followed by bevacizumab (CPB) and secondary cytoreduction surgery in platinum-sensitive recurrent ovarian cancer: GOG0213, an NRG Oncology/GOG Study—Analysis of patient reported outcomes (PRO) on chemotherapy randomization.

5525 Purpose: GOG 213 is a bifactorial, phase III, randomized trial studying the efficacy and tolerability of the incorporation of B and secondary cytoreduction in women with platinum sensitive rec...

Cytoreductive surgery for late recurrence after surgically treated stage IV ovarian cancer-a case report

Recurrence is a common finding after surgically treated ovarian cancer even in cases submitted to initially R0 resection. However, it is well known that an aggressive surgical approach is perfectly justified at the moment of relapse, being the only solution in order to increase the survival rates. We present the case of a 62 year old patient who was previously submitted to surgery for stage IV ovarian cancer followed by 6 cycles of adjuvant chemotherapy. At 4 years follow up she was diagnosed with disseminated abdominal recurrences and she was submitted to secondary cytoreduction. Postoperatively, adjuvant chemotherapy with platinum based regimens was instituted.

Hyperthermic intraperitoneal chemotherapy (secondary cytoreduction CRS + HIPEC) for recurrent epithelial ovarian cancer (EOC): Indian experience.

e16536 Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) has been proposed as treatment for recurrent epithelial ovarian carcinoma. We evaluate...

Diagnostic value of combined 18F-FDG positron emission tomography/computed tomography in recurrent epithelial ovarian cancer with non-disseminated lesions: Correlation with pathologic diagnosis of the secondary cytoreduction

Objectives: To evaluate the diagnostic accuracy of combined 18F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging in suspected recurrence of epithelial ovarian cancer with nondisseminated lesions by correlating with pathologic diagnosis after the secondary cytoreduction.