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1
Memarzadeh, S., S. B. Lee, J. S. Berek, and R. Farias-Eisner. "CA125 levels are a weak predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer." International Journal of Gynecologic Cancer 13, no. 2 (February 2003): 120–24. http://dx.doi.org/10.1136/ijgc-00009577-200303000-00003.
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The utility of preoperative CA125 to predict optimal primary tumor cytoreduction in patients with advanced (stages IIIC and IV) epithelial ovarian cancer is controversial. In this paper, we retrospectively review patients with stage IIIC and IV epithelial ovarian cancer who underwent primary cytoreductive surgery from 1989 to 2001. Ninety-nine patients were identified and included in the analysis. All patients had preoperative CA125 levels measured. Operative and pathology reports were reviewed. Optimal cytoreduction was defined as largest volume of residual disease < 1 cm in maximal dimension. Mean values were compared with t-test on a log scale when needed. The optimal cut-point for discriminating between those with vs. without optimal cytoreduction was determined using the receiver operator curve (ROC) method. Optimal cytoreduction was achieved in 73% of patients. Among patients with optimal cytoreductive status the mean CA125 level was 569, while among patients with suboptimal cytoreduction the mean CA125 level was 1520 (P < 0.007). A CA125 level of 912 was identified as the optimal cut-point to distinguish the two groups. Using this CA125 level, the sensitivity of this test in predicting optimal cytoreduction was 58% and the specificity was 54%. The positive predictive value of CA125 for optimal cytoreduction was 78% and the negative predictive value was 31%. We conclude that CA125 level is a weak positive and negative predictor of optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer. The CA125 level should not be used as a primary predictor of the outcome of cytoreductive surgery and should be viewed in the context of all other preoperative features.
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Lūža, Tomas, Agnė Ožalinskaitė, and Vilius Rudaitis. "The rate and role of diaphragmatic peritonectomy in optimal cytoreduction in patients with advanced stage ovarian cancer: a prospective study of 100 patients." Acta medica Lituanica 21, no. 1 (April 30, 2014): 1–7. http://dx.doi.org/10.6001/actamedica.v21i1.2882.
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Background. Diaphragmatic peritoneal metastasis by advanced epithelial ovarian cancer is a very common holdback precluding optimal cytoreduction. The aim of this study was to determine the rate of diaphragmatic peritonectomy during optimal cytoreductive surgery and its role in postoperative morbidity and survival in patients with advanced ovarian cancer. Materials and methods. 100 consecutive patients with advanced epithelial ovarian cancer underwent cytoreductive surgery and were followed up prospectively (January 2009 – March 2014). Characteristics of surgery, rate of diaphragmatic peritonectomy and post operative complications were assessed. The Kaplan-Meier method was used for survival analysis. Results. The median age of the entire cohort at the time of primary cytoreduction was 58.5 years (23–83). Optimal cytoreduction was achieved in 73 cases out of 100 patients. From 73 patients in 30 cases (41.1%) upper abdominal procedures, specifically diaphragmatic peritonectomy, was performed to achieve the main goal of cytoreduction – no visible or palbable disease at the end of cytoreduction. Non-optimal cytoreduction was achieved in 27 cases. According to the Clavien-Dindo complication grading system grade I and grade II complications occurred more often in patients that underwent diaphragmatic surgery. The median overall survival from the time of diagnosis to the last follow-up or death was 28 months (range 0–63 months). The factors associated with the longest survival after primary cytoreductive surgery were the disease free interval from the primary cytoreduction of more than 19 months (n = 51) versus less than 19 months (n = 49) (95% confidence interval, 51.7–59.5; P = 0.013) and no visible or palpable residual disease at the end of cytoreduction (n = 73) versus visible or palpable residual disease (n = 27) (95% confidence interval, 52.7–61.2; P = 0.03). Conclusions. Based on our prospective analysis of advanced ovarian cancer patients, diaphragmatic peritonectomy is feasible and safe, ensures better rates of optimal cytoreduction and should not be an obstacle towards better survival.
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A, Camargo, Bianchi F, Habich D, and Castaño R. "The fundamental role of the exploration of the upper abdomen in ovarian cancer surgery." Obstetrics & Gynecology International Journal 12, no. 5 (October 28, 2021): 337–42. http://dx.doi.org/10.15406/ogij.2021.12.00603.
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Purpose: Several studies have shown the benefit of cytoreductive surgery in advanced disease, that is why the residual tumor has prognostic value. Our primary objective was to determine the frequency of involvement of the upper abdomen, defined as the extension of the disease above the transverse colon (diaphragm, spleen, gallbladder, stomach, hepatic parenchyma, hepatic capsule, minor omentum, hepatic ilium, pancreas). Our secondary objective was to analyze the possibilities of complete cytoreduction in these patients, their complications and results. Materials and methods: We retrospectively include patients undergoing primary and secondary cytoreduction due to ovarian carcinoma between January 2008 and December 2012, in the gynecology department of the German Hospital. Results: One hundred and thirty nine patients with ovarian carcinoma were analyzed. An average age of 60 years (28-90). 91 of them with attempted primary cytoreduction and 48 secondary cytoreduction. In the group of primary cytoreductions we excluded 17 patients that were stages I and II, 20 (22%) of the 74 stages III-IV had upper abdomen involvement, 17 stages III and 3 stages IV. Those stage IV patients were only limited to hepatic intraparenchymal involvement. Of the 48 secondary cytoreductions, 21 (43%) presented upper abdominal involvement. Including both groups we have 30% of upper abdomen compromise. Complete or optimal cytoreduction was achieved in 56% of them. Conclusion: The exploration of the superior abdomen in ovarian cancer surgery is key, and the approach of this patients by a team of properly trained gynecologists is mandatory if we want to obtain better complete cytoreduction rates.
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Abdullaev, A. G., М. M. Davydov, and N. A. Коzlov. "CHALLENGES IN CHOICE OF THE TREATMENT STRATEGY FOR PATIENTS WITH RECURRENT PSEUDOMYXOMA PERITONEI." Siberian journal of oncology 18, no. 3 (June 30, 2019): 78–83. http://dx.doi.org/10.21294/1814-4861-2019-18-3-78-83.
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Pseudomixoma peritonei is a rare type of peritoneal carcinomatosis accompanied by accumulation of mucus and high recurrence rate and in some cases complicated with intestinal obstruction. In the last 10–15 years, there has been observed a significant improvement in overall survival of patients with recurrent pseudomyxoma, who underwent cytoreductive surgery in combination with intraperitoneal chemotherapy. However, the frequency of recurrences of peritoneal pseudomyxoma after optimal cytoreduction can reach 80–90 % in the first 2 years.The purpose of the study was to analyze the results of combined therapy (cytoreductive surgery and hypothermic intraperitoneal chemoperfusion) in patients with recurrent pseudomyxoma peritonei, who previously underwent cytoreductive surgery.Material and Methods. The study included 43 patients previously undergoing cytoreductive surgery for pseudomyxoma peritonei in the Thoracic Oncology Department of the N.N. Blokhin National Medical Research Center of Oncology.Results. Re-operations were performed in 11 of the 43 patients with recurrent pseudomixoma peritonei after previously performed cytoreductive surgery. Repeated intraperitoneal chemoperfusion with hyperthermia was performed in 6 patients. Of the 11 reoperated patients, 7 had a complete cytoreduction (CC-0), recurrence was detected within 22 to 47 months; 2 patients had CC-1 and recurrence was observed within 12 and 15 months. Optimal cytoreduction (CC0-1) was achieved in 7 of the 11 patients. The maximum follow-up period was 44 months. Recurrence was noted in 9 patients, while the majority of patients had a satisfactory quality of life. Two patients showed signs of partial intestinal obstruction. None of the patients died during the follow-up period. In two patients with optimal (CC-0) cytoreduction, there were no signs of disease progression 9 and 15 months after re-surgery. One-year disease-free survival rate was 51 %.Conclusion. Repeated surgeries for recurrent pseudomyxoma present a great challenge for surgeons due to the difficulty in achieving optimal cytoreduction. Optimal cytoreduction in initial surgery should be considered as the main condition for repeated surgery. Moreover, additional criterion for a favorable prognosis is the time to progression of disease.
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Turan, Taner, Tolga Tasci, Alper Karalok, Isin Ureyen, Ozgur Kocak, Osman Turkmen, Derman Basaran, and Gokhan Tulunay. "Salvage Cytoreductive Surgery for Recurrent Endometrial Cancer." International Journal of Gynecologic Cancer 25, no. 9 (November 2015): 1623–32. http://dx.doi.org/10.1097/igc.0000000000000543.
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ObjectiveThe aim of this study was to determine the effect of salvage cytoreductive surgery (SCS) on overall survival (OS) among patients with recurrent endometrial cancer and if there is any predictor for residual tumor status.MethodsBetween January 1993 and May 2013, data of 34 patients who had SCS for recurrent endometrial cancer were retrospectively analyzed. Overall survival was determined from SCS to last follow-up.ResultsThe surgical procedure was local excision without laparotomy in 12 patients, and optimal cytoreduction (no visible disease) was achieved in 24 of 34 patients. There were no perioperative deaths. None of the factors was associated with achievement of optimal cytoreduction. Five-year OS rates were 37% and 27% for the entire cohort and for the laparotomy group, respectively. For the entire cohort, disease-free interval (from initial surgery to recurrence), adjuvant therapy after initial surgery, CA-125 level at recurrence, multiplicity of recurrence, surgical procedure, and optimal cytoreduction and for the laparotomy group adjuvant treatment and optimal cytoreduction were associated with OS. In the laparotomy group, OS rates were 53 and 9 months in the patients who did and did not have optimal SCS, respectively.ConclusionsSignificant survival benefit can be achieved with optimal resection. Prospective studies should be designed to define optimal cytoreduction and to determine the predictors of optimal cytoreduction achievement.
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Roberts, William S. "Cytoreductive Surgery in Ovarian Cancer: Why, When, and How?" Cancer Control 3, no. 2 (March 1996): 130–36. http://dx.doi.org/10.1177/107327489600300205.
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Retrospective evidence supports the value of optimal cytoreductive surgery in the initial therapy of patients with advanced ovarian cancer. Specialized procedures, including radical pelvic surgery, bowel resection, and diaphragm resections, are frequently necessary to accomplish optimal cytoreduction. Cytoreduction and total gross tumor removal are possible more frequently with new surgical instruments such as the Cavitron ultrasonic surgical aspirator and argon beam laser. Pelvic and periaortic lymph node resection is an important aspect of cytoreductive surgery, and systematic removal of grossly uninvolved lymph nodes may improve survival. Secondary cytoreductive surgery appears to benefit a select group of patients.
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Abdalla Ahmed, Shimaa, Hisham Abou-Taleb, Noha Ali, and Dalia M. Badary. "Accuracy of radiologic– laparoscopic peritoneal carcinomatosis categorization in the prediction of surgical outcome." British Journal of Radiology 92, no. 1100 (August 2019): 20190163. http://dx.doi.org/10.1259/bjr.20190163.
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Objective: To evaluate the agreement between multiple detector CT (MDCT) and laparoscopy in the preoperative categorization of peritoneal carcinomatosis, and to determine the impact of this categorization on the prediction of cytoreduction status. Methods: This prospective study included 80 consecutive females with primary ovarian cancer eligible for cytoreductive surgery (CRS). MDCT and diagnostic laparoscopy were performed prior to surgery for assessment of peritoneal carcinomatosis extent. Based on PCI (peritoneal cancer index) score, carcinomatosis was categorized into three groups. Categorization agreement between CT and laparoscopy was assessed and compared with the intraoperative-histopathologically proven PCI. Impact of PCI categorization on cytoreduction status was also evaluated. Results: The overall agreement between CT and laparoscopy in preoperative peritoneal carcinomatosis categorization was good (K =0.71-0.79) in low category group and excellent in both moderate and large group (interclass correlation coeeficient = 0.89–0.91). (p<0.01) Optimal cytoreduction was achieved in 62/80 (77.5%) patients, PCI < 20 was detected in 48/62 (77.4%), pre-operative PCI < 20 correctly predicted optimal cytoreductive surgery (OCS) in 40/48 (83.3%) cases. Suboptimal cytoreduction was performed in 18/80 (22.5%) patients. PCI > 20 was detected in (10/18) 55.6%, preoperative CT and laparoscopy PCI > 20 correctly predicted SCS in 8/10 (80%) cases. The area under receiver operating characteristic curve showed that PCI cut-off <20 was the best predictor of OCS with an accuracy 85%, sensitivity 97%, specificity 40%, negative predictive value 76%, and positive predictive value 93%. Conclusion: Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended. Advances in knowledge: Both laparoscopy and CT are equally effective in pre-operative peritoneal carcinomatosis categorization. PCI < 20 is accurate in the prediction of optimal cytoreduction. More than half of patients with suboptimal cytoreduction had PCI > 20 and interval debulking surgery can be recommended.
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Cardillo, Nicholas, Eric J. Devor, Silvana Pedra Nobre, Andreea Newtson, Kimberly Leslie, David P. Bender, Brian J. Smith, Michael J. Goodheart, and Jesus Gonzalez-Bosquet. "Integrated Clinical and Genomic Models to Predict Optimal Cytoreduction in High-Grade Serous Ovarian Cancer." Cancers 14, no. 14 (July 21, 2022): 3554. http://dx.doi.org/10.3390/cancers14143554.
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Advanced high-grade serous (HGSC) ovarian cancer is treated with either primary surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval surgery. The decision to proceed with surgery primarily or after chemotherapy is based on a surgeon’s clinical assessment and prediction of an optimal outcome. Optimal and complete cytoreductive surgery are correlated with improved overall survival. This clinical assessment results in an optimal surgery approximately 70% of the time. We hypothesize that this prediction can be improved by using biological tumor data to predict optimal cytoreduction. With access to a large biobank of ovarian cancer tumors, we obtained genomic data on 83 patients encompassing gene expression, exon expression, long non-coding RNA, micro RNA, single nucleotide variants, copy number variation, DNA methylation, and fusion transcripts. We then used statistical learning methods (lasso regression) to integrate these data with pre-operative clinical information to create predictive models to discriminate which patient would have an optimal or complete cytoreductive outcome. These models were then validated within The Cancer Genome Atlas (TCGA) HGSC database and using machine learning methods (TensorFlow). Of the 124 models created and validated for optimal cytoreduction, 21 performed at least equal to, if not better than, our historical clinical rate of optimal debulking in advanced-stage HGSC as a control. Of the 89 models created to predict complete cytoreduction, 37 have the potential to outperform clinical decision-making. Prospective validation of these models could result in improving our ability to objectively predict which patients will undergo optimal cytoreduction and, therefore, improve our ovarian cancer outcomes.
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Abdallah, Reem, Hye Sook Chon, Nadim Bou Zgheib, Douglas C. Marchion, Robert M. Wenham, Johnathan M. Lancaster, and Jesus Gonzalez-Bosquet. "Prediction of Optimal Cytoreductive Surgery of Serous Ovarian Cancer With Gene Expression Data." International Journal of Gynecologic Cancer 25, no. 6 (July 2015): 1000–1009. http://dx.doi.org/10.1097/igc.0000000000000449.
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ObjectivesCytoreductive surgery is the cornerstone of ovarian cancer (OVCA) treatment. Detractors of initial maximal surgical effort argue that aggressive tumor biology will dictate survival, not the surgical effort. We investigated the role of biology in achieving optimal cytoreduction in serous OVCA using microarray gene expression analysis.MethodsFor the initial model, we used a gene expression signature from a microarray expression analysis of 124 women with serous OVCA, defining optimal cytoreduction as removal of all disease greater than 1 cm (with 64 women having optimal and 60 suboptimal cytoreduction). We then applied this model to 2 independent data sets: the Australian Ovarian Cancer Study (AOCS; 190 samples) and The Cancer Genome Atlas (TCGA; 468 samples). We performed a second analysis, defining optimal cytoreduction as removal of all disease to microscopic residual, using data from AOCS to create the gene signature and validating results in TCGA data set.ResultsOf the 12,718 genes included in the initial analysis, 58 predicted accuracy of cytoreductive surgery 69% of the time (P= 0.005). The performance of this classifier, measured by the area under the receiver operating characteristic curve, was 73%. When applied to TCGA and AOCS, accuracy was 56% (P= 0.16) and 62% (P= 0.01), respectively, with performance at 57% and 65%, respectively. In the second analysis, 220 genes predicted accuracy of cytoreductive surgery in the AOCS set 74% of the time, with performance of 73%. When these results were validated in TCGA set, accuracy was 57% (P= 0.31) and performance was at 62%.ConclusionGene expression data, used as a proxy of tumor biology, do not predict accurately nor consistently the ability to perform optimal cytoreductive surgery. Other factors, including surgical effort, may also explain part of the model. Additional studies integrating more biological and clinical data may improve the prediction model.
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Abitbol, Jeremie, Walter Gotlieb, Ziggy Zeng, Agnihotram Ramanakumar, Roy Kessous, Liron Kogan, Valerie Pare-Miron, et al. "Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy." International Journal of Gynecologic Cancer 29, no. 9 (October 9, 2019): 1341–47. http://dx.doi.org/10.1136/ijgc-2019-000413.
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IntroductionWith the rapid uptake of robotic surgery in surgical oncology, its use in the treatment of epithelial ovarian cancers is being evaluated. Complete cytoreduction represents the goal of surgery either at primary cytoreduction or after neoadjuvant chemotherapy in the setting of interval cytoreduction. In selected patients, the extent of disease would enable minimally invasive surgery. The objective of this study was to evaluate the impact of introducing robotic surgery for interval cytoreduction of selected patients with stage III–IV ovarian cancer.MethodsAll patients who underwent surgery from November 2008 to 2014 (concurrent time period when robotic and open surgery were used simultaneously) after receiving neoadjuvant chemotherapy for advanced ovarian cancer (stage III–IV) were compared with all consecutive patients who underwent cytoreductive surgery by laparotomy after neoadjuvant chemotherapy between January 2006 and November 2008. Inclusion criteria included an interval cytoreductive surgery by laparotomy or robotic assistance for stage III–IV non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer. Exclusion criteria included patients treated concurrently for a non-gynecologic cancer, as well as secondary cytoreductive surgeries and diagnostic surgeries without an attempt at tumor reduction. Overall survival, progression-free survival, and peri-operative outcomes were compared for the entire patient cohort with those with advanced ovarian cancer who received neoadjuvant chemotherapy immediately before and after the introduction of robotic surgery.ResultsA total of 91 patients were selected to undergo interval cytoreduction either via robotic surgery (n=57) or laparotomy (n=34) after the administration of neoadjuvant chemotherapy. The median age of the cohort was 65 years (range 24–88), 78% had stage III disease, and the median follow-up time was 37 months (5.6–91.4 months). The median survival was 42.8±3.1 months in the period where both robotic surgery and laparotomy were offered compared with 37.9±9.8 months in the time period preceding when only laparotomy was performed (p=0.6). All patients selected to undergo interval robotic cytoreduction following neoadjuvant chemotherapy had a reduction of cancer antigen 125 by at least 80%, resolution of ascites, and CT findings suggesting the potential to achieve optimal interval cytoreduction. All these patients achieved optimal cytoreduction with <1 cm residual disease, including 82% with no residual disease. The median blood loss was 100 mL (mean 135 mL, range 10–1250 mL), and the median hospital stay was 1 day.ConclusionRobotic interval cytoreductive surgery is feasible in well-selected patients. Future studies should aim to define ideal patients for minimally invasive cytoreductive surgery.
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Ayhan, A., C. Taskiran, C. Celik, K. Yuce, and T. Kucukali. "The influence of cytoreductive surgery on survival and morbidity in stage IVB endometrial cancer." International Journal of Gynecologic Cancer 12, no. 5 (2002): 448–53. http://dx.doi.org/10.1136/ijgc-00009577-200209000-00007.
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The purpose of this study was to detect possible survival advantages of surgical cytoreduction and different adjuvant treatment regimens for stage IVB endometrial cancer patients, and also to evaluate the prognostic importance of surgico-pathological risk factors and surgical morbidity rates.Thirty-seven FIGO stage IVB endometrial cancer patients treated at the Hacettepe University Hospital between 1977 and 1998 were included in this study. Clinical data were obtained from the private oncology files and all specimens were re-evaluated by the co-author pathologist. Optimal cytoreduction was defined as a surgical procedure leaving the patient with ≤1 cm residual disease in maximal diameter. All patients were subjected to initial cytoreductive surgery, but it had been achieved for 22 (60%) patients. Fourteen (38%) patients received both radiotherapy and chemotherapy, 10 (27%) patients received only radiotherapy and the other 10 (27%) patients received only chemotherapy. Three patients refused any type of adjuvant therapy.The median survival of the suboptimally cytoreduced patients was 10 months, while the median survival in the optimal group was 25 months (P = 0.001). In optimal cytoreduction group, the median survival for 12 (55%) patients without visible tumor was 48 months compared to 13 months in 10 (45%) patients with visible tumor. As an adjuvant treatment, concomitant cisplatin and radiotherapy revealed 54 months median survival compared to 15 and 13 months in patients treated with only radiotherapy and only chemotherapy, respectively. By univariate analysis, extra-abdominal metastases, suboptimal cytoreduction, visible tumoral mass after cytoreduction, pelvic-para-aortic lymphatic metastases, and cervical invasion were found to be significant predictors of poor survival. In multivariate analysis, optimal cytoreduction, concomitant cisplatin-radiotherapy treatment, and extra-abdominal metastases were significant. Morbidity was mild in six (16%), and severe in nine (24%) patients.We conclude that optimal cytoreduction achieved significant survival benefit for stage IVB endometrial cancer patients with a reasonable surgical morbidity rate. As an adjuvant treatment, concomitant cisplatin and radiotherapy was the best choice.
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Kumar, D. Suresh, S. Navin Noushad, and M. P. Viswanathan. "Pelvic lymphadenectomy as a component of interval cytoreduction for ovarian cancer: is there a benefit? A pilot study." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 821. http://dx.doi.org/10.18203/2320-6012.ijrms20170515.
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Background: Management strategy in ovarian cancer includes a combination of cytoreductive surgery and chemotherapy. Interval cytoreductive surgery has been shown to be oncologically non-inferior to primary cytoreduction with the additional benefit of reduced morbidity. Lymphadenectomy as a component of cytoreductive surgery has been controversial with an unproven therapeutic benefit.Methods: Records of patients with a histological diagnosis of ovarian cancer and treated with interval cytoreduction were evaluated. Disease related, pathological and treatment data collected for analysis.Results: The study included 32 patients with a mean age of 56 years (41-76). Serous papillary tumors (42%) were the predominate histology and the majority were in stage III disease (84%). Optimal cytoreduction was achieved in 93%. The mean nodal harvest was 9.8 nodes with left pelvic dissection yielding slightly more nodes than the right (4.5 vs 5.2). Nodal positivity was observed in just one patient (3%). A total of 314 were nodes examined with only 2 (0.6%) yielding persistent disease. The nodal positivity yield tested as a categorical variable by the binomial test returned P=0.0001.Conclusions: It is possible to omit pelvic nodal dissection during interval cytoreduction in otherwise optimally cytoreduced patients particularly when imaging and intraoperative assessment are not suggestive of pelvic nodal metastasis.
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Bridges, J. E., Y. Leung, I. G. Hammond, and A. J. Mccartney. "En bloc resection of epithelial ovarian tumors with concomitant rectosigmoid colectomy: the KEMH experience." International Journal of Gynecologic Cancer 3, no. 4 (1993): 199–202. http://dx.doi.org/10.1046/j.1525-1438.1993.03040199.x.
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Between the years 1984 and 1988, 43 patients with bulky advanced stage epithelial ovarian carcinoma underwent en bloc pelvic resection with excision of the rectosigmoid colon as part of their primary cytoreductive surgery. Optimal cytoreduction was accomplished in over 70% of cases, and all women had complete debulking of their pelvic tumor. Primary anastomosis of the bowel was feasible in all cases and only two covering colostomies were performed. There were no postoperative leaks or fistulas. The postoperative morbidity was reflected by a mean postoperative hospital stay of 16 days. Our results suggest that this technique facilitates optimal cytoreduction of bulky pelvic tumor with an acceptably low morbidity in woman with advanced ovarian carcinoma.
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Rybin, A. I. "The results of personificated ovarian cancer patients with peritoneal carcinomatosis treatment." Reproductive health of woman, no. 7 (November 30, 2022): 35–40. http://dx.doi.org/10.30841/2708-8731.7.2022.272470.
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The objective: to analyse of the experience of cytoreductive surgery using and hypenermic intraperitoneal chemperfusion (HIPEC) in patients with ovarian cancer IIIC stage, as well as overall and relapse-free survival in such patients. Materials and methods. 119 patients with ovarian cancer of the IIIC stage were involved into the study from 2013 to 2020 and they were treated at the University Clinic of Odessa National Medical University. Patients were divided into two groups: the clinical control group (n=53) included persons after suboptimal cytoreduction; the patients of the main group (n=66) had optimal or complete cytoreduction, and in some cases with subsequent intraoperative hyperthermic intraperitoneal chemotherapy. During the initial analysis of these groups, time (preoperative period, duration of surgery, number of postoperative bed-days), as well as the presence of complications in the postoperative period were determined. Results. In the main group there was an increase operation time due to large surgery volumes and the implementation of the HIPEC procedure with primary cytoreduction (p=0.001). In the postoperative period, an increase in the number of bed-days in the hospital in patients of the main group in relation to the control group was established, especially in those who had HIPEC (p=0.001). There was an increase in the number of surgical complications of class III-IV according to the Clavien-Dindo classification (from 5 % to 22.2 %) in patients after HIPEC. An increase in relapse-free survival from 10 months in the control group to 13-19 months in the main group was revealed. The recurrence median in the postoperative period in the control group was 10±1.3 months, and after interval cytoreduction and primary cytoreduction with HIPEC – 13±1.5 and 19±6.3 months, respectively. The index of relapse-free survival in the first 6 months in the control group was 63.2 %, in patients after optimal or complete cytoreduction – 88.0 %, in patients after optimal or complete cytoreduction and HIPEC – 90.4 %. One-year recurrence-free survival rate was 37.5 %, 63.2 % and 60.1 %, respectively, the average values of overall survival – 27.7±4.1 months versus 24.5±1.8 and 24.1±2.2 months, respectively. Conclusions. Cytoreductive surgery and methods of intraoperative hyperthermic intraperitoneal chemotherapy are perspective options of treatment of patients with peritoneal carcinomatosis by ovarian cancer regarding recurrence of the disease and survival, although they are accompanied by more postoperative complications and number of bed-days in hospital.
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Angarita, Ana Milena, Rebecca Stone, Sarah M. Temkin, Kimberly Levinson, Amanda N. Fader, and Edward J. Tanner. "The Use of “Optimal Cytoreduction” Nomenclature in Ovarian Cancer Literature: Can We Move Toward a More Optimal Classification System?" International Journal of Gynecologic Cancer 26, no. 8 (October 2016): 1421–27. http://dx.doi.org/10.1097/igc.0000000000000796.
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ObjectivesThe objective of this study is to explore how cytoreductive surgical outcomes such as residual disease (RD) and use of the term “optimal cytoreduction” (OCR) have changed over time in the ovarian cancer literature.MethodsWe identified all English-language publications referring to ovarian cancer cytoreduction for a 12-year period. Publications were evaluated for how the diameter of RD was categorized and whether OCR was defined. In addition, the use of RD and OCR terminology trends over time and associations between terminology and the region of corresponding author, study type, and journal impact factor were explored.ResultsOf the 772 publications meeting inclusion criteria, the RD stratification points used to demarcate patient groups were as follows: 0 mm (45%), 5 mm (3.6%), 10 mm (65%), and 20 mm (24%). The use of 0-mm RD (odds ratio [OR], 1.1; 95% confidence interval, 1.05–1.15) and 10-mm RD (OR, 1.1; 95% confidence interval, 1.09–1.20) to delineate patient outcomes increased over time. The use of OCR terminology did not change over time but was more commonly used in clinical studies as well as those from North America. Many studies (70%) defined OCR as less than or equal to 10-mm RD, whereas 30% defined OCR differently or not at all.ConclusionsOptimal cytoreduction terminology remains ambiguous and inconsistently used in the ovarian cancer surgical literature. On the basis of this literature review, we propose a novel classification system to categorize RD without reference to OCR while accurately and succinctly identifying meaningful clinical subgroups and minimizing bias.
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Bandala-Jacques, Antonio, Fabiola Estrada-Rivera, David Cantu, Diddier Prada, Gonzalo Montalvo-Esquivel, Aarón González-Enciso, and Salim Abraham Barquet-Munoz. "Role of optimal cytoreduction in patients with dysgerminoma." International Journal of Gynecologic Cancer 29, no. 9 (October 7, 2019): 1405–10. http://dx.doi.org/10.1136/ijgc-2019-000632.
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BackgroundDysgerminomas are malignant ovarian germ-cell tumors that typically affect young women. Although these tumors have an excellent response to chemotherapy, surgery is an integral part of primary treatment.ObjectiveTo evaluate outcomes of initial cytoreduction in patients diagnosed with dysgerminomas.MethodsPatients who underwent primary cytoreductive surgery for ovarian dysgerminoma between January 1985 and December 2013 were identified and included in the study. A comparison was made between patients who underwent optimal versus sub-optimal cytoreduction. Descriptive, comparative statistics and odds ratios were used to establish an association. Survival curves were performed with the Kaplan-Meier method and compared using a log-rank test. A value of p<0.05 was used to establish a statistical difference.ResultsA total of 180 patients with a histologically confirmed dysgerminoma were included in the analysis. A subsection of 37 patients in stages III/IV were analyzed. The median age at diagnosis was 21 years (IQR 18–26). Histologically, 166 (92.2%) patients had pure dysgerminomas, whereas the rest had mixed histologies. The median tumor size was 18 (IQR 12–22) cm. In all stages, factors associated with optimal cytoreduction, were higher lactate dehydrogenase levels (OR=1.01; p=0.03), higher CA125 levels (OR=1.01; p=0.04), receiving adjuvant chemotherapy (OR=0.22; p<0.01), or undergoing treatment in a specialized institution (OR=12.68; p<0.01). Patients in stages III/IV, initially managed outside our institution were less likely to be taken for cytoreduction (OR=16.88; p=0.013). Other factors, including age (OR=1.02; p=0.39), pelvic lymph-node positivity (OR=2.24; p=0.36), pregnancy during follow-up (OR=0.91: p=0.80), or recurrence of disease (OR=1.93; p=0.23) were found to be similar in both groups. Overall survival was higher in optimally cytoreducted patients (100% vs 95.7%; p=0.032) including all stages, but not if considering only stages III/IV (100% vs 90%, p=0.186); disease-free survival was the same for both groups regardless of stage (94.3% vs 91.1%; p=0.36).ConclusionPatients with optimal surgeries were most likely to be treated in referral centers. Initial residual disease did not significantly alter recurrence, progression, disease-free survival, or overall survival.
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Wakabayashi, Mark T., Paul S. Lin, and Amy A. Hakim. "The Role of Cytoreductive/Debulking Surgery in Ovarian Cancer." Journal of the National Comprehensive Cancer Network 6, no. 8 (September 2008): 803–11. http://dx.doi.org/10.6004/jnccn.2008.0060.
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Ovarian cancer is the fifth most common cause of cancer-related death among women in the United States, although the median survival of patients has been increasing over the past few decades. In patients with epithelial ovarian cancer, chemotherapy has increased survival. Platinum agents combined with taxanes have become standard treatment. Intraperitoneal chemotherapy has also increased survival. Cytoreductive surgery to optimally debulk a tumor or, ideally, remove any gross disease has also been shown to increase survival. Each 10% increase in cytoreduction correlates with a 5.5% increase in median survival. The ability to successfully perform optimal cytoreduction ranges from 20% to 90%. Many institutions have recently begun to perform aggressive/ultraradical procedures to achieve this result. Interval cytoreduction may also benefit patients whose initial surgery is suboptimal, especially if the first procedure was performed by a surgeon unfamiliar with the disease. Secondary cytoreduction can increase survival in patients with low-volume disease and a long disease-free interval. All of these procedures should be performed by a specialist trained in ovarian cancer surgery.
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Tjulandina, A. S., A. A. Rumyantsev, K. Y. Morkhov, V. M. Nechushkina, and S. A. Tjulandin. "RETROSPECTIVE ANALYSIS OF LONG-TERM SURVIVAL OUTCOMES OF PRIMARY CYTOREDUCTION AND NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH OVARIAN CANCER STAGE IIIC–IV." Malignant tumours 8, no. 3 (November 13, 2018): 86–94. http://dx.doi.org/10.18027/2224-5057-2018-8-3-86-94.
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The choice of treatment strategy in patients with stage IIIC‑IV ovarian cancer (OC) remains the subject of numerous discussions. The reason for this is the unsatisfactory results of randomized trials and the low frequency of primary complete debulking surgery in these studies. We conducted a retrospective analysis to evaluate the survival outcomes in patients with OC stage IIIC–IV (n=314) who underwent treatment between 1995 and 2017. The median progression free survival for primary surgery was 15.6 months, after interval debulking – 11.5 months (p=0.002, HR 0.61: 95 % CI 0.39–0.81). The primary cytoreduction significantly increased the median of overall survival by 19.6 months: from 38.0 months after interval debulking up to 57.6 months after primary cytoreduction (p=0.04, HR 0.64: 95 % CI 0.41–0.99). An increase in the number of optimal interval debulking does not lead to an improvement in the long-term results of treatment in the group of patients after neoadjuvant chemotherapy. Our analysis over the past 20 years has shown that improvement in treatment outcomes is only observed in the primary cytoreduction group due to an increase in the number of complete optimal cytoreductive surgery.
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Tuninetti, Valentina, Marilena Di Napoli, Eleonora Ghisoni, Furio Maggiorotto, Manuela Robella, Giulia Scotto, Gaia Giannone, et al. "Cytoreductive Surgery for Heavily Pre-Treated, Platinum-Resistant Epithelial Ovarian Carcinoma: A Two-Center Retrospective Experience." Cancers 12, no. 8 (August 10, 2020): 2239. http://dx.doi.org/10.3390/cancers12082239.
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Few retrospective studies have shown a benefit in selected patients affected by heavily pre-treated, platinum-resistant ovarian carcinomas (PROCs) who have undergone cytoreduction at relapse. However, the role of tertiary and quaternary cytoreductive surgery is not fully defined. Our aim was to evaluate survival and surgical morbidity and mortality after maximal cytoreduction in this setting. We evaluated all consecutive patients undergoing cytoreduction for platinum-resistance over an 8-year period (2010–2018) in two different centers. Fifty patients (median age 52.5 years, range 34–75) were included; the median number of previous chemotherapy lines was three (range 1–7) and the median number of previous surgeries was one (range 1–4). Completeness of cytoreduction (CC = 0) was achieved in 22 patients (44%). Rates of major operative morbidity and 30-day mortality were 38% and 8%, respectively. Median follow-up was 35 months. The absence of tumor residual (CC = 0) was associated with a significantly better overall survival (OS) compared to the CC > 0 subgroup (median OS 32.9 months (95% CI 21.6–44.2) vs. 4.8 months (95% CI n.a.–9.8), hazard ratio (HR) 4.21 (95% CI 2.07–8.60), p < 0.001). Optimal cytoreduction is feasible and associated with promising OS in selected, heavily pre-treated PROCs. Further prospective studies are required to better define the role of surgery in platinum-resistant disease.
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Koirala, Pratistha, Ashley S. Moon, and Linus Chuang. "Clinical Utility of Preoperative Assessment in Ovarian Cancer Cytoreduction." Diagnostics 10, no. 8 (August 7, 2020): 568. http://dx.doi.org/10.3390/diagnostics10080568.
Full textAbstract:
Ovarian cancer is the deadliest gynecologic cancer, in part due to late presentation. Many women have vague early symptoms and present with disseminated disease. Cytoreductive surgery can be extensive, involving multiple organ systems. Novel therapies and recent clinical trials have provided evidence that, compared to primary cytoreduction, neoadjuvant chemotherapy has equivalent survival outcomes with less morbidity. There is increasing need for validated tools and mechanisms for clinicians to determine the optimal management of ovarian cancer patients.
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Bacalbasa, Nicolae, Olivia Ionescu, Paris Ionescu, and Irina Balescu. "Digestive resections in advanced-stage ovarian cancer." Advances in Modern Oncology Research 2, no. 3 (June 16, 2016): 132. http://dx.doi.org/10.18282/amor.v2.i3.87.
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The standard frontline treatment for advanced-stage ovarian cancer (ASOC) consists of maximal cytoreduction surgery associated with platinum/paclitaxel-based chemotherapy. Several studies have proven that patients with no gross residual disease (RD) have better survival rates than those with optimal but visible RD (RD ≤1 cm). In order to achieve this, more radical cytoreductive procedures such as radical pelvic resection and extensive upper abdominal procedures are performed. However, some investigators have suggested that, although effective, radical surgery cannot fully compensate tumor biology, which is a major determinant in survival and in turn influences the likelihood of surgical cytoreduction. The aim of this review was to present the procedures defining ultra-radical (extensive) surgery and to evaluate its feasibility and morbidity in the management of ASOC.
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Nelson, B. E., A. T. Rosenfield, and P. E. Schwartz. "Preoperative abdominopelvic computed tomographic prediction of optimal cytoreduction in epithelial ovarian carcinoma." Journal of Clinical Oncology 11, no. 1 (January 1993): 166–72. http://dx.doi.org/10.1200/jco.1993.11.1.166.
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PURPOSE This study was undertaken to assess the ability of computed tomography (CT) to predict the likelihood of optimal primary tumor cytoreduction in women with epithelial ovarian carcinoma. PATIENTS AND METHODS Fifty-one women with preoperative CT and a histologic diagnosis of epithelial ovarian carcinoma following primary tumor operation by a gynecologic oncologist were identified. Forty-two CT scans were retrospectively analyzed. CT findings of attachment of the omentum to the spleen or disease greater than 2 cm on the diaphragm, liver surface, or parenchyma, pleura, mesentery, gallbladder fossa, or suprarenal paraaortic nodes were coded to represent unresectable disease. CT results were compared with surgical outcome. RESULTS Twenty-nine of 42 (69%) patients underwent optimal cytoreduction to less than 2 cm residual disease. Successful cytoreduction was accomplished in 23 of 24 patients who fulfilled CT criteria for cytoreduction and six of 18 with CT criteria predictive of inability to perform cytoreduction. CT was highly sensitive for detection of ascites, mesenteric, and omental disease, but was poor for detection of liver involvement, omental attachment to the spleen, gallbladder fossa disease, and peritoneal nodules smaller than 2 cm. The CT findings accurately predicted surgical outcome with a sensitivity of 92.3% and specificity of 79.3%. The positive predictive value was 67% and the negative predictive value was 96%. CONCLUSION CT scan is an accurate method for the prediction of successful surgical cytoreduction and may have utility in the decision to offer neoadjuvant chemotherapy to certain medically disabled patients, a hypothesis currently under evaluation.
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Vasquez, Flavia Morales, Ricardo Raziel Peña Gonzalez, and Horacio Noé López Basave. "Predictive factors of cytoreductive surgery in epithelial ovarian cancer in a Mexican women cohort." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e17099-e17099. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17099.
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e17099 Background: Cytoreductive surgery is the most important prognostic factor in ovarian cancer. To identify in a timely manner the patients who are not candidates for optimal debulking, does not delay and optimize the treatment. Objetive: Identify the presurgical factors that characterize patients in whom optimal cytoreduction is not possible. Methods: Observational study in a retrospective cohort (n = 255) that compared pre-surgical factors between patients with optimal debulking (n = 65) and suboptimal (n = 190). Non-parametric tests were used, a Cox proportional hazards model was constructed and survival curves were drawn by method of Kaplan y Meier. Results: 255 patients were included. 75% achieved optimal debulking. 9 out of 10 evaluated tomography criteria showed association (p < 0.001) with suboptimal cytoreduction. The best cut-off value of Ca-125 to predict suboptimal surgery was 774 IU / mL. Only clinical ascites showed association with the result of the surgery (p < 0.001). There was no difference in complications between both groups (p = 0.267). The rate of optimal debulking has improved over time (p = 0.049). The turn of the surgeries has no impact on the overall survival of the patients (p = 0.792). Conclusions: Objective parameters (tomography and laboratory) should be used to select patients who are not candidates for surgery. The Clinical evaluation without objective parameters is not enough
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Winarno, Gatot Nyarumenteng Adhipurnawan, Yudi Mulyana Hidayat, Setiawan Soetopo, Sofie Rifayani Krisnadi, Maringan Diapari Lumban Tobing, and Syahrul Rauf. "The Ability Pre-operative Serum (Cancer Antigen-125, Fatty Acid Synthase, and Glucose Transporter) to Predict Primary Suboptimal Cytoreduction in Epithelial Ovarian Cancer." Open Access Macedonian Journal of Medical Sciences 8, A (November 4, 2020): 858–65. http://dx.doi.org/10.3889/oamjms.2020.4817.
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BACKGROUND: The incidence of ovarian cancer ranks 8th in the world, with 295,414 cases and 184,799 death in 2018. Management in ovarian cancer is surgery and chemotherapy. Some studies state that patients who underwent optimal cytoreduction surgery have better survival rates than suboptimal cytoreduction surgery. The pre-operative serum assessed in this study was Cancer Antigen-125 (CA-125), Fatty Acid Synthase (FASN), and Glucose Transporter (GLUT) to predict suboptimal cytoreduction in epithelial ovarian cancer (EOC).
AIM: We aimed to use FASN and GLUT1 as other biomarkers, besides CA-125, to predict suboptimal cytoreduction surgery in epithelial ovarian cancer.
METHODS: This observational-analytic cross-sectional study included 109 women diagnosed with epithelial ovarian cancer (EOC) between 2017 and 2019, who had serum CA-125, FASN, and GLUT measured preoperatively and underwent cytoreductive surgery.
RESULTS: The results of the statistical analysis test in this study obtained p values at CA-125 (p = 0.0001), FASN (p = 0.017), and at GLUT (p = 0.013). While the cutoff point (COP) on CA-125 was 248.55, FASN was 0.445, and GLUT was 0.1980. The value of area under curve (AUC) obtained by the ROC method at CA-125 76.7%, FASN 65.3%, and GLUT 63.8%. The combination of CA-125 and FASN shows AUC value 76.9%, the combination of CA-125 and GLUT shows AUC value 72.2%, and the combination of the three shows AUC value 75.2%.
CONCLUSION: The use of CA-125 as a predictor of cytoreduction surgery is still considered to be the best predictor compared to serum biomarkers in this study.
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Lorusso, D., M. Mancini, R. Di Rocco, R. Fontanelli, and F. Raspagliesi. "The Role of Secondary Surgery in Recurrent Ovarian Cancer." International Journal of Surgical Oncology 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/613980.
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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.
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Kim, Rachel Soyoun, Janet Malcolmson, Xuan Li, Marcus Bernardini, Liat Frida Hogen, and Taymaa May. "The correlation between BRCA status and surgical cytoreduction in high-grade serous ovarian carcinoma." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 5543. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.5543.
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5543 Background: High grade serous ovarian cancers (HGSC) with BRCA mutation are biologically unique, with distinct molecular and clinical behaviour from sporadic cases. It is unclear if these biological differences translate to favorable outcomes at the time of primary cytoreductive surgery (PCS). The aim of this study is to compare the amount of residual disease following PCS in BRCA-mutated (BRCAm) and wildtype (BRCAwt) HGSC, and to assess whether BRCA status is an independent predictor of residual disease. Methods: We conducted a retrospective analysis of patients with HGSC with known germline and somatic BRCA mutation status, treated with PCS from 2000 to 2017. We compared the cytoreduction outcomes between the BRCAm and the BRCAwt cohorts and built a predictive model to assess whether BRCA status was associated with amount of residual disease at the time of PCS. Results: Of 355 women, 144 harbored germline or somatic BRCA mutations (41%) and 211 were BRCAwt (59%). BRCAm women tended to be younger (54 vs. 59; p < 0.001), but there were no differences between the two groups in stage, disease burden at presentation, surgical complexity score, length of surgery, or perioperative complications. The BRCAm group had a higher rate of complete cytoreduction to no residual disease (0mm) [75% vs. 54%], and a lower rate of optimal cytoreduction (1-9mm) [16% vs. 34%] or suboptimal cytoreduction (≥10mm) [9% vs. 12%] (p < 0.001). In our predictive model, after accounting for length of surgery, CA-125 level, stage, disease scores and surgical complexity scores, BRCAm status was predictive of complete cytoreduction to 0mm residual disease (OR 4.78; 95% CI 2.32-9.85; p < 0.001). Conclusions: BRCA status is predictive of complete cytoreduction at time of PCS in HGSC. Timely availability of BRCA testing is paramount as it may aid in the therapeutic decision making between PCS or neoadjuvant chemotherapy in women with newly diagnosed HGSC.
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Fader, Amanda Nickles, and Peter G. Rose. "Role of Surgery in Ovarian Carcinoma." Journal of Clinical Oncology 25, no. 20 (July 10, 2007): 2873–83. http://dx.doi.org/10.1200/jco.2007.11.0932.
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Surgery plays a critical role in the optimal management of all stages of ovarian carcinoma. In apparent early-stage ovarian cancer, a comprehensive surgical evaluation allows stratification of patients into low- and high-risk categories. Low-risk patients may be candidates for fertility-sparing surgery and can safely avoid chemotherapy and be observed. Treatment of patients with high-risk early- or advanced-stage ovarian cancer usually requires a combined modality approach. Although it is well known that epithelial ovarian cancer is moderately chemosensitive, what distinguishes it most from other metastatic solid tumors is that surgical cytoreduction of tumor volume is highly correlated with prolongation of patient survival. Procedures such as radical pelvic surgery, bowel resection, and aggressive upper abdominal surgery are commonly required to achieve optimal cytoreduction. Women who develop recurrent disease may be eligible for a secondary cytoreductive surgery or may require a surgical intervention to palliate disease-related symptoms. For women at high risk of ovarian cancer, prophylactic bilateral salpingo-oophorectomy significantly reduces the incidence of this disease. The purpose of this article is to provide a comprehensive review of the surgical management of ovarian carcinoma. The roles of primary, interval, and secondary cytoreductive surgeries; second-look procedures; and palliative surgery are reviewed. The indications for fertility-sparing and minimally invasive surgery as well as the current guidelines for prophylactic surgery in high-risk mutation carriers are also discussed.
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Risum, Signe, Estrid Høgdall, Svend A. Engelholm, Eric Fung, Lee Lomas, Christine Yip, Anette L. Petri, Lotte Nedergaard, Lene Lundvall, and Claus Høgdall. "A Proteomics Panel for Predicting Optimal Primary Cytoreduction in Stage III/IV Ovarian Cancer." International Journal of Gynecologic Cancer 19, no. 9 (November 2009): 1535–38. http://dx.doi.org/10.1111/igc.0b013e3181a840f5.
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The objective of this prospective study was to evaluate CA-125 and a 7-marker panel as predictors of incomplete primary cytoreduction in patients with stage III/IV ovarian cancer (OC). From September 2004 to January 2008, serum from 201 patients referred to surgery for a pelvic tumor was analyzed for CA-125. In addition, serum was analyzed for 7 biomarkers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. These biomarkers were combined into a single-valued ovarian-cancer-risk index (OvaRI). CA-125 and OvaRI were evaluated as predictors of cytoreduction in 75 stage III/IV patients using receiver operating characteristic curves.Complete primary cytoreduction (no macroscopic residual disease) was achieved in 31% (23/75) of the patients. The area under the receiver operating characteristic curve was 0.66 for CA-125 and 0.75 for OvaRI.The sensitivity and specificity of CA-125 for predicting incomplete cytoreduction were 71% (37/52) and 57% (13/23), respectively (P = 0.04). The sensitivity and specificity of OvaRI for predicting incomplete cytoreduction were 73% (38/52) and 70% (16/23), respectively (P = 0.001). In conclusion, CA-125 and an index of 7 biomarkers were found to be predictors of cytoreduction. However, future studies of biomarkers are anticipated to promote early diagnosis and provide prognostic information to guide treatment of OC patients. In addition, new biomarkers might also play a role in predicting outcome from primary surgery in OC patients.
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de Jong, D., J. E. Dodge, O. Freedman, E. Lo, B. P. Rosen, and H. Mackay. "Predictors for optimal cytoreduction following neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 5512. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.5512.
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5512 Background: Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients (pts) with presumed advanced-stage epithelial ovarian cancer (EOC) who are deemed ineligible for upfront debulking surgery (DS). DS following NAC offers a survival benefit to those pts in whom optimal cytoreduction (< 1 cm residual tumor) is achieved. However, not all women who commence NAC have a subsequent attempt at DS. The aims of this study were to identify, in pts planned for NAC, predictive parameters for attempting DS and for achieving optimal cytoreduction in those undergoing surgery. Methods: Pts with presumed stage IIIC or IV EOC who started NAC between 1998 and 2004 were selected for chart review from our institutional ovarian cancer database. Pts with synchronous primary tumors or final pathology inconsistent with EOC were excluded. Age, presence of ascites, Pre NAC hemoglobin (Hb), platelet count (Pls), and CA-125 were explored as possible predictors of attempting DS and of optimal cytoreduction using Kruskal-Wallis analysis and multivariate regression analysis with backward elimination. Results: 212 pts met inclusion criteria. 164 pts (77.4%) had an attempt at DS after NAC; of these 109 pts (66.4%) were optimally cytoreduced. Age and pre-NAC Pls were independent predictors for attempting DS. Median age of pts undergoing DS was 65 years (range 42–82 yrs) compared to 77 yrs (range 54–89 yrs) in those in whom there was no DS attempt, p < 0.01. Median pre NAC Pls of pts undergoing DS was 398 (range 220–685) *109/L, compared to 298 (178–519) for those not proceeding to DS, p < 0.001. Pre NAC Hb, CA125, and ascites were not predictors of DS. Among pts undergoing DS, age was the only independent predictor of optimal cytoreduction identified: median age of pts (optimal vs. suboptimal cytoreduction) was 57yrs (range 42–73 yrs) vs. 67 yrs (49–82yrs), p < 0.001. Presence of ascites, pre-NAC Hb, pre-NAC Pls, and pre-NAC CA-125 were not predictors of optimal cytoreduction. Conclusions: At our centre, pt age and pre-NAC Pls are independent predictors for attempting DS following NAC for advanced stage EOC. In pts undergoing DS age was the only independent predictor of optimal cytoreduction identified. Further investigation of these findings is warranted. No significant financial relationships to disclose.
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Lekawale, Hemant S., and Rachana V. Gaidole. "Outcomes of surgery in epithelial ovarian cancer: our experience." International Surgery Journal 6, no. 11 (October 24, 2019): 3906. http://dx.doi.org/10.18203/2349-2902.isj20194576.
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Background: Comprehensive surgical staging and surgical cytoreduction is the primary modality of treatment in early and advanced epithelial ovarian cancer respectively, followed by systemic chemotherapy in most of the patients. The aim of the present study was to evaluate the role of surgery and its impact on disease free and overall survival in patients with epithelial ovarian cancer.Methods: A retrospective analysis of 38 patients of biopsy proven epithelial ovarian cancer was performed. Patient’s demographic data, details of surgical procedure, post-operative complications, histopathological findings, staging and pattern of recurrence were collected from the medical records.Results: Six (15.8%) patients had early disease (stage I-II) at presentation while 30 (94.7%) patients advanced disease (stage III-IV). Staging laparotomy was done in six (15.8%) patients, primary cytoreduction in eight (21.05%) patients, interval cytoreduction in 17 (81.6%) patients and secondary cytoreduction in two (5.3%) patients. Five (13.2%) patients were inoperable. The median follow up time was in the range of 2 to 56 months (median 26 months). The three years overall survival in advanced stage was 73.74%. Disease free survivals in primary and interval cytoreduction groups were 80% and 58.67% respectively. The disease free survival in patients with optimal cytoreduction was 72.9%.Conclusions: The present study indicates that in the majority of patients with advanced ovarian cancer, surgery can lead to optimal cytoreduction with acceptable disease-free and overall survival.
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Pomel, Christophe, Cherrif Akladios, Eric Lambaudie, Roman Rouzier, Gwennael Ferron, Fabrice Lecuru, Jean-Marc Classe, et al. "Laparoscopic management of advanced epithelial ovarian cancer after neoadjuvant chemotherapy: a phase II prospective multicenter non-randomized trial (the CILOVE study)." International Journal of Gynecologic Cancer 31, no. 12 (October 20, 2021): 1572–78. http://dx.doi.org/10.1136/ijgc-2021-002888.
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ObjectiveThe aim of this study was to explore the feasibility and safety of the laparoscopic approach after neoadjuvant chemotherapy among selected chemosensitive patients with advanced ovarian cancer.MethodsThe CILOVE study was a phase II prospective non-randomized multicenter study. It aimed to enroll 47 women with unresectable disease at the time of initial diagnosis (International Federation of Gynecology and Obstetrics (FIGO) stage IV and/or diffuse extensive carcinomatosis for advanced FIGO stage IIIC or patients unfit to withstand radical primary surgery), in response to chemotherapy and fit to undergo laparoscopy.ResultsAmong the 48 patients enrolled in the trial, 44 (92%) patients underwent exploratory staging laparoscopy and, as a result, 41 patients were eligible for cytoreductive surgery. Among them, 32 were intended to be managed by laparoscopy and nine patients were managed by laparotomy. The conversion rate to laparotomy was 9.4% (3/32) and the reasons were multiple surgical adhesions (n=1), miliary carcinomatosis and adhesion to the intraperitoneal mesh (n=1), and poor laparoscopic evaluation of transverse colon involvement (n=1). All except one patient had optimal cytoreduction (97% complete cytoreduction, 3% incomplete cytoreduction (residual tumor <2.5 mm)). The median operative time was 267 min (range 146–415) and the median estimated blood loss was 150 mL (range 0–500). Two patients had intra-operative complications: one diaphragm rupture that was repaired during laparoscopy and one bradycardia. Six patients experienced early post-operative complications (<1 month), but there were no grade 3 and 4 complications (3 infections, 1 lymphoedema, 2 hemorrhage). After cytoreductive laparoscopy, the percentage of patients without progression at 12 months was 87.5%.ConclusionsInterval ovarian cytoreduction by a laparoscopic approach is safe and feasible for patients with a favorable response to chemotherapy. With the widespread use of neoadjuvant chemotherapy in the management of advanced ovarian cancer, a minimally invasive approach may be a potential option.
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Malfetano, John H. "Splenectomy for optimal cytoreduction in ovarian cancer." Gynecologic Oncology 24, no. 3 (July 1986): 392–94. http://dx.doi.org/10.1016/0090-8258(86)90319-7.
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Dhiman, Pravesh, P. P. Bapsy, C. N. Patil, and Renu Raghupathi. "Is Optimal Cytoreduction Post Neoadjuvant Chemotherapy the Only Prognostic Factor in Advanced Ovarian Cancer?" South Asian Journal of Cancer 11, no. 03 (July 2022): 207–12. http://dx.doi.org/10.1055/s-0042-1755291.
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Background Epithelial ovarian cancer (EOC) is one of the leading causes of cancer-related death in women. Approximately 70% of patients with EOC are diagnosed in advanced stage [The International Federation of Gynecology and Obstetrics(FIGO stage III and IV)] with an expected 5-year survival rate of 30%. Numerous studies have shown that survival with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is noninferior to primary debulking surgery followed by chemotherapy. Materials and Methods In this retroprospective observational study, 50 patients with advanced ovarian cancer, diagnosed from January 2012 to January 2015, were included and followed-up till January 2017. Correlation of NACT with patient profile, CA125 levels, clinicopathologic parameters, progression-free survival (PFS), and treatment response was studied. Statistical analysis was performed using log-rank test and Kaplan-Meir survival plots. Results The extent of cytoreduction significantly correlated with PFS. The PFS was maximum in patients who had optimal cytoreduction (19 months) and 10 months in patients with suboptimal cytoreduction with p-value < 0.05. The survival was not significantly correlated with other parameters such as age, stage, preoperative CA125 levels, and ascites. Conclusions The extent of cytoreduction following NACT in this study was associated with statistically significant PFS advantage in patients who were able to undergo optimal cytoreduction, but not significantly correlated to other factors such as age, stage, preoperative CA125 levels, and ascites. NACT followed by interval cytoreduction is an important modality affecting survival in advanced EOC. Further studies and longer follow-up are needed to demonstrate survival advantage over standard treatment.
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Braicu, Ioana, Wanja Nikolai Kassuhn, Hagen Kulbe, Pauline Wimberger, Cagatay Taskiran, Klaus Pietzner, Alexander Mustea, et al. "Improving the prediction of surgical outcome at secondary cytoreduction in patients with ovarian cancer: Results from retrospective part of HELP-ER study NOGGO TR2/ENGOT OV47-TR." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 5558. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.5558.
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5558 Background: Complete resection at secondary cytoreductive surgery is associated with prolonged progression free and overall survival for patients with relapsed ovarian cancer. Secondary cytoreductive surgery has no impact on survival rates, if macroscopically tumor clearance cannot be achieved. Therefore, in order to avoid unnecessary perioperative morbidity and mortality, selection of patients who will undergo secondary tumor debulking is crucial. This study aims to improve upon the contemporary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) score by including additional clinical variables like circulating HE4 and CA125 levels to predict surgical outcome at secondary cytoreduction. Methods: A total of 90 patients underwent secondary cytoreductive surgery and were retrospectively assigned a positive AGO score. Of those patients, 62 (68.9%) achieved optimal surgical outcome at secondary debulking with 28 (31.1%) patients retaining residual tumor mass ( > 0mm). Utilizing clinical variables including circulating HE4 and CA125 levels, we implemented a machine learning workflow to predict suboptimal surgical outcome in patients despite a positive AGO score. Results: We elucidated significantly lower levels of circulating HE4 (p = 0.0038) in patients with optimal surgical outcome compared to patients that retain macroscopic residual tumor at secondary cytoreductive surgery. Moreover, machine learning algorithms trained on clinical variables (e.g. serum HE4 level, serum CA125 level, age, Risk of Ovarian Malignancy Algorithmus (ROMA) score and occurrence of peritoneal carcinomatosis) achieved a mean area under the curve (AUC) of 78.4% based on 100 consecutive executions with randomized training and test sets. Conclusions: The application of machine learning allows to further improve the prediction of patients with high likelihood of achieving optimal surgical outcome at secondary cytoreduction. In turn, it might identify patients that would benefit from amplified treatment efforts. However, machine learning relies on large amounts of data to account for biological and clinical variation and produce predictions of sufficient/adequate quality. Given this limitation, we would validate this data within the prospective multicentric cohort of patients collected within NOGGO/ENGOT HELP_ER Trial.
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Di Donna, Mariano Catello, Giuseppe Cucinella, Giulia Zaccaria, Giuseppe Lo Re, Agata Crapanzano, Sergio Salerno, Vincenzo Giallombardo, et al. "Concordance of Radiological, Laparoscopic and Laparotomic Scoring to Predict Complete Cytoreduction in Women with Advanced Ovarian Cancer." Cancers 15, no. 2 (January 13, 2023): 500. http://dx.doi.org/10.3390/cancers15020500.
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Objective: To identify the best method among the radiologic, laparoscopic and laparotomic scoring assessment to predict the outcomes of cytoreductive surgery in patients with advanced ovarian cancer (AOC). Methods: Patients with AOC who underwent pre-operative computed tomography (CT) scan, laparoscopic evaluation, and cytoreductive surgery between August 2016 and February 2021 were retrospectively reviewed. Predictive Index (PI) score and Peritoneal Cancer Index (PCI) scores were used to estimate the tumor load and predict the residual disease in the primary debulking surgery (PDS) and interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) groups. Concordance percentages were calculated between the two scores. Results: Among 100 eligible patients, 69 underwent PDS, and 31 underwent NACT and IDS. Complete cytoreduction was achieved in 72.5% of patients in the PDS group and 77.4% in the IDS. In patients undergoing PDS, the laparoscopic PI and the laparotomic PCI had the best accuracies for complete cytoreduction (R0) [area under the curve (AUC) = 0.78 and AUC = 0.83, respectively]. In the IDS group, the laparotomic PI (AUC = 0.75) and the laparoscopic PCI (AUC= 0.87) were associated with the best accuracy in R0 prediction. Furthermore, radiological assessment, through PI and PCI, was associated with the worst accuracy in either PDS or IDS group (PI in PDS: AUC = 0.64; PCI in PDS: AUC = 0.64; PI in IDS: AUC = 0.46; PCI in IDS: AUC = 0.47). Conclusion: The laparoscopic score assessment had high accuracy for optimal cytoreduction in AOC patients undergoing PDS or IDS. Integrating diagnostic laparoscopy in the decision-making algorithm to accurately triage AOC patients to different treatment strategies seems necessary.
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Тkachenko, O. I., O. V. Bondar, S. G. Chetverikov, V. E. Maksymovskyi, M. S. Chetverikov, and V. V. Chetverikova–Ovchynnyk. "Peritoneoectomy and the multiorgan resection in prevalent tumors of abdominal cavity and small pelvis." Klinicheskaia khirurgiia 88, no. 3-4 (July 28, 2021): 58–63. http://dx.doi.org/10.26779/2522-1396.2021.3-4.58.
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Objective. To estimate the results of peritoneoectomy and multiorgan resection in the treatment of prevalent tumors of abdominal cavity and small pelvis.
Materials and methods. The results of treatment of 246 patiemts with prevalent abdominal cavity tumors were studied. The patients were distributed into two groups: Group I – 209 patients, to whom complete and optimal cytoreduction was performed, and Group II – 37 patients, to whom suboptimal cytoreduction was done. Intraoperative characteristics, the term of stationary stay, postoperative morbidity, lethality, timeliness of intestinal function restoration and the patients’ quality of life were estimated.
Results. The cytoreduction volume increase enhances the postoperative morbidity rate, connected predominantly with multiple resection of intestine and surgery of diaphragm. In patients of Group I degradation of the quality of life indices was noted through 1 mo postoperatively.
Conclusion. Using multiorgan resection and peritoneoectomy it is possible to achieve complete and optimal volume of cytoreduction. Application of multidisciplinary approach, new operative procedures, modern surgical instruments and energies permit to reduce the postoperative morbidity rate.
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Lof, Pien, Roelien van de Vrie, Catharina M. Korse, Willemien J. van Driel, Mignon D. J. M. van Gent, Mona A. Karlsen, Frederic Amant, and Christianne A. R. Lok. "Pre-operative prediction of residual disease after interval cytoreduction for epithelial ovarian cancer using HE4." International Journal of Gynecologic Cancer 29, no. 8 (September 11, 2019): 1304–10. http://dx.doi.org/10.1136/ijgc-2019-000581.
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BackgroundPresence of residual disease after cytoreductive surgery is an important negative prognostic factor for patients with advanced stage epithelial ovarian cancer. Surgery is of limited benefit when the diameter of residual disease is >1 cm. Residual disease is difficult to predict before surgery. The multivariate model Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index, based on serum biomarker HE4, age, and World Health Organization performance status, predicted no visible residual disease in patients undergoing primary cytoreductive surgery with an area under the curve (AUC) of 0.85. The AUC of predicting residual disease >1 cm was not reported, although this can be of importance for pre-operative decision making, especially in fragile patients. We tested this model for predicting residual disease >1 cm in patients undergoing interval cytoreduction.MethodsWe retrospectively included patients with advanced epithelial ovarian cancer who underwent interval cytoreduction between January 2010 and December 2017 in two tertiary centers in the Netherlands. HE4 was measured with electrochemiluminescence in pre-operative samples. The CONATS index was used to predict residual disease. AUCs were calculated to predict residual disease >1 cm.ResultsA total of 273 patients were included. Mean (SD) age was 64 (11) years. Median number of cycles of neoadjuvant chemotherapy was 3 (range 3–6) and the most common regimen used consisted of carboplatin and paclitaxel. Before interval cytoreduction, 19 patients (7%) showed complete response to chemotherapy, 251 patients (92%) showed partial response, and 3 patients (1%) showed stable disease at imaging. Following surgery, 232 patients (85%) had residual disease ≤1 cm and 41 patients (15%) had residual disease >1 cm. The AUC was 0.80 for predicting residual disease >1 cm. In patients ≥70 years of age the AUC was 0.82.ConclusionThe CONATS index predicts surgical outcome after interval cytoreduction and is useful in counseling patients about the chance of whether an optimal interval cytoreduction can be achieved. This could be especially helpful in counseling elderly patients in whom surgery has a high risk of complications.
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Hamulyák, Eva N., Joost G. Daams, Frank W. G. Leebeek, Bart J. Biemond, Peter A. W. te Boekhorst, Saskia Middeldorp, and Mandy N. Lauw. "A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms." Blood Advances 5, no. 1 (January 5, 2021): 113–21. http://dx.doi.org/10.1182/bloodadvances.2020003628.
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Abstract Patients with myeloproliferative neoplasms (MPNs), polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have an increased risk of thrombosis. Risk of recurrent thrombosis can be reduced with antithrombotic therapy and/or cytoreduction, but the optimal long-term management in patients with MPN with a history of venous thromboembolism (VTE) is unknown, and clinical practice is heterogeneous. We performed a systematic review and meta-analysis of randomized trials and observational studies evaluating anticoagulant and/or antiplatelet therapy, with or without cytoreduction, in MPN patients with a history of VTE. A total of 5675 unique citations were screened for eligibility. No randomized trials were identified. Ten observational studies involving 1295 patients with MPN were included in the analysis. Overall, 23% had an arterial or recurrent venous thrombotic event on follow-up. The recurrence risk was lowest for patients on oral anticoagulation plus cytoreduction (16%); 55 of 313 (18%) with vitamin K antagonists (VKA) and 5 of 63 (8%) with direct oral anticoagulants (DOACs). In 746 analyzed patients, the risk of recurrent VTE ranged up to 33% (median 13%) and was low in 63 DOAC plus cytoreduction-treated patients (3.2%). All types of antithrombotic treatments were associated with a lower risk of recurrent VTE when combined with cytoreduction. Most studies had a high risk of bias, whereas clinical and statistical heterogeneity led to inconsistent and imprecise findings. In summary, evidence on the optimal antithrombotic treatment of VTE in patients with MPN is based on observational studies only with low certainty for all strategies. Our data suggest that a combination of anticoagulation and cytoreduction may provide the lowest recurrence risk.
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Hamulyák, Eva N., Joost G. Daams, Frank W. G. Leebeek, Bart J. Biemond, Peter A. W. te Boekhorst, Saskia Middeldorp, and Mandy N. Lauw. "A systematic review of antithrombotic treatment of venous thromboembolism in patients with myeloproliferative neoplasms." Blood Advances 5, no. 1 (January 5, 2021): 113–21. http://dx.doi.org/10.1182/bloodadvances.2020003628.
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Abstract Patients with myeloproliferative neoplasms (MPNs), polycythemia vera, essential thrombocythemia, and primary myelofibrosis, have an increased risk of thrombosis. Risk of recurrent thrombosis can be reduced with antithrombotic therapy and/or cytoreduction, but the optimal long-term management in patients with MPN with a history of venous thromboembolism (VTE) is unknown, and clinical practice is heterogeneous. We performed a systematic review and meta-analysis of randomized trials and observational studies evaluating anticoagulant and/or antiplatelet therapy, with or without cytoreduction, in MPN patients with a history of VTE. A total of 5675 unique citations were screened for eligibility. No randomized trials were identified. Ten observational studies involving 1295 patients with MPN were included in the analysis. Overall, 23% had an arterial or recurrent venous thrombotic event on follow-up. The recurrence risk was lowest for patients on oral anticoagulation plus cytoreduction (16%); 55 of 313 (18%) with vitamin K antagonists (VKA) and 5 of 63 (8%) with direct oral anticoagulants (DOACs). In 746 analyzed patients, the risk of recurrent VTE ranged up to 33% (median 13%) and was low in 63 DOAC plus cytoreduction-treated patients (3.2%). All types of antithrombotic treatments were associated with a lower risk of recurrent VTE when combined with cytoreduction. Most studies had a high risk of bias, whereas clinical and statistical heterogeneity led to inconsistent and imprecise findings. In summary, evidence on the optimal antithrombotic treatment of VTE in patients with MPN is based on observational studies only with low certainty for all strategies. Our data suggest that a combination of anticoagulation and cytoreduction may provide the lowest recurrence risk.
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Zang, R. Y., Z. T. Li, Z. Y. Zhang, and S. M. Cai. "Surgery and salvage chemotherapy for Chinese women with recurrent advanced epithelial ovarian carcinoma: A retrospective case-control study." International Journal of Gynecologic Cancer 13, no. 4 (2003): 419–27. http://dx.doi.org/10.1136/ijgc-00009577-200307000-00004.
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The objective of this paper is to clarify the role of cytoreductive surgery and salvage chemotherapy in the management of recurrent advanced epithelial ovarian carcinoma (RAEOC) and to identify factors affecting disease recurrence. One hundred sixty seven patients with RAEOC treated at the Cancer Hospital of Fudan University between January 1986 and December 1997 were retrospectively reviewed. Survival was calculated by Kaplan-Meier method with difference in survival estimated by the log-rank test. Independent prognostic factors were identified by the Cox stepwise regression model and variants associated with disease recurrence were determined using logistic stepwise regression methods. The median age was 52 (range 27–72) years. Sixty (35.9%) patients underwent re-debulking surgery, 23 of them with residual disease ≤1 cm. There was a significant difference in survival between optimal and suboptimal groups, with an estimated median survival of 18 and 13 months, respectively (P = 0.021, χ2 = 9.42). When patients with suboptimal surgical results were compared to those with chemotherapy alone, there was a significant difference in median survival, 13 vs. 16 months (P = 0.0364, χ2 = 4.38). Residual disease after primary surgery, neoadjuvant chemotherapy, and salvage chemotherapy was a predictor of survival identified by Cox regression analysis, but secondary cytoreductive surgery did not reach a level of statistical significance (P = 0.0561). Logistic stepwise regression analysis showed that age, first-line chemotherapy, neoadjuvant chemotherapy, and the size of residual disease after primary surgical cytoreduction were factors affecting disease recurrence. We conclude that patients with RAEOC benefit from optimal secondary surgical cytoreduction. Should the recurrence not be optimally cytoreduced by surgery, alternative salvage chemotherapy is best for RAEOC.
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Popović, Miroslav, Tanja Milić-Radić, and Arnela Cerić-Banićević. "The clinical and pathological characteristics and survival of patients with advanced ovarian cancer." Scripta Medica 52, no. 3 (2021): 205–10. http://dx.doi.org/10.5937/scriptamed52-33897.
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Introduction: Ovarian cancer has the highest mortality rate of all gynaecologic malignancies. The aim of this study was the evaluation of the clinical pathological characteristics and survival analysis of primarily operated patients with advanced stages of malignant epithelial ovarian tumour. Methods: The research was conducted as a cohort study with 59 patients with FIGO stage III and IV, which were primarily operated between 1 January 2008 and 31 December 2010 (three years). Age, comorbidities, BMI, presence of ascites, the level of the marker CA-125, histopathology and FIGO stage were analysed. The survival rate was estimated at the level of 1, 3 and 5 years. Results: The median age was 53 years (range 29-86). The most common histopathological type was serous (66.1 %) and the most common FIGO stage was 3a (49.2 %). Optimal cytoreduction was performed in 35.5 % of patients, 84.7 % of patients survived for one year, 44.1 % three years and 37.3 % for five years. The median survival was 26.25 months (range 0-91). Chi-square test showed significant difference between the number of months of survival and: the value of CA125 (t = 2.004, p = 0.050), cytoreduction (p < 0.001) and FIGO stage (p < 0.01). Conclusion: According to the results of this study, optimal cytoreduction and FIGO stage significantly influence survival (p < 0.001). Optimal cytoreduction (< 2 cm of residual disease) had the highest prognostic value for survival. A total five-year survival in this study was 37.3 %.
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Kolev, Valentin, Svetlana Mironov, Oleg Mironov, Nicole Ishill, Chaya S. Moskowitz, Ginger J. Gardner, Douglas A. Levine, Hedvig Hricak, Richard R. Barakat, and Dennis S. Chi. "Prognostic Significance of Supradiaphragmatic Lymphadenopathy Identified on Preoperative Computed Tomography Scan in Patients Undergoing Primary Cytoreduction for Advanced Epithelial Ovarian Cancer." International Journal of Gynecologic Cancer 20, no. 6 (July 2010): 979–84. http://dx.doi.org/10.1111/igc.0b013e3181e833f5.
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Introduction:It has been hypothesized that the supradiaphragmatic lymph nodes serve as the principal nodes for lymphatic drainage of the entire peritoneal cavity. The purpose of this study was to determine the prognostic significance of enlarged supradiaphragmatic nodes noted on preoperative computed tomographic (CT) scan in patients undergoing primary cytoreduction for advanced epithelial ovarian cancer (EOC).Methods:We performed a retrospective chart review of all patients with stage III and IV EOC according to the International Federation of Gynecology and Obstetrics who had preoperative CT scans, including the supradiaphragmatic region, and had undergone primary cytoreductive surgery at our institution between January 1997 and June 2004. Scans were retrospectively reviewed by a radiologist. We defined supradiaphragmatic adenopathy as nodes measuring greater than 5 mm on the largest of 2 perpendicular measurements on the CT scan. The Fisher exact test was used to compare proportions. Kaplan-Meier curves and log-rank tests were used for the survival analyses.Results:A total of 212 evaluable patients were identified. All underwent attempted primary cytoreduction followed by systemic chemotherapy. None had any supradiaphragmatic nodes removed at primary cytoreduction. With a median follow-up time of 52 months, median overall survival for the entire cohort was 48 months. Of 212 patients, 92 (43%) had supradiaphragmatic adenopathy. Median survival was 50 months for patients without adenopathy and 45 months for patients with adenopathy (P = 0.09). Of the 212 patients, 155 (73%) underwent optimal cytoreduction. In these patients, median survival was 55 months for the 91 without adenopathy and 50 months for the 64 patients with supradiaphragmatic adenopathy (P = 0.09).Conclusions:We observed a trend toward worse survival in patients with enlarged supradiaphragmatic nodes. The prognostic impact of supradiaphragmatic adenopathy remains uncertain and deserves further study.
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Rahaman, J., P. Dottino, T. S. Jennings, J. Holland, and C. J. Cohen. "The second-look operation improves survival in suboptimally debulked stage III ovarian cancer patients." International Journal of Gynecologic Cancer 15, no. 1 (January 2005): 19–25. http://dx.doi.org/10.1136/ijgc-00009577-200501000-00004.
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In a single-institution retrospective cohort study, 230 patients were treated for stage III primary ovarian cancer and 175 became eligible for second-look operations by virtue of a complete clinical response after primary surgical cytoreduction and platinum-based combination chemotherapy. Of these, 109 underwent a second-look operation. Optimal primary cytoreduction was defined as residual disease ≤1 cm. Median follow-up was 68.3 months. Five-year survival for all the 230 stage III ovarian cancers was 43.4%. Among all eligible patients (n = 175), there was no survival difference (P = 0.67) in those having second look (57.3%, 5-year survival) versus no second look (48.7%). In those patients with optimal primary cytoreduction (n = 118), there was no survival advantage to second look (69% versus 61%, P = 0.7). However, in those with suboptimal primary cytoreduction (n = 47), 5-year survival was 36% in those having second look versus only 13% in those refusing second look (P < 0.05). Multivariate analysis identified second-look surgery as the only significant independent prognostic variable affecting survival (RR = 0.321, P < 0.04). Patients with suboptimal debulking at primary surgery for stage III ovarian cancer appear to achieve a survival benefit from second-look surgical procedures, presumably from the early identification and treatment of residual disease.
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Eisenkop, Scott M., Nick M. Spirtos, and Wei-Chien Michael Lin. "“Optimal” cytoreduction for advanced epithelial ovarian cancer: A commentary." Gynecologic Oncology 103, no. 1 (October 2006): 329–35. http://dx.doi.org/10.1016/j.ygyno.2006.07.004.
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Simons, E., T. Kiet, I. Amanam, M. Ho, J. Fuh, K. Fuh, D. Kapp, K. Odunsi, and J. Chan. "Immune signatures predictive of optimal cytoreduction in ovarian cancer." Gynecologic Oncology 125 (March 2012): S46. http://dx.doi.org/10.1016/j.ygyno.2011.12.108.
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Richardson, M. T., S. Routson, A. K. Karam, O. Dorigo, and E. Diver. "Role of CA-125 in achieving optimal secondary cytoreduction." Gynecologic Oncology 159 (October 2020): 94. http://dx.doi.org/10.1016/j.ygyno.2020.05.081.
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Sahin, R., U. Nayki, P. Ulug, C. Nayki, E. Gultekin, A. Ozdemir, B. Kaya, B. Pilanci, K. Ertopcu, and Y. Yildirim. "302A. Cytoreductive surgery in advanced endometrial cancer: The impact of optimal cytoreduction and adjuvant treatment method." European Journal of Surgical Oncology (EJSO) 40, no. 11 (November 2014): S119. http://dx.doi.org/10.1016/j.ejso.2014.08.293.
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Malynovskyi, A. V., V. V. Grubnik, and I. Z. Gladchuk. "Cytoreductive surgery and hyperthermal intraperitoneal chemoperfusion in colorectal cancer and cancer of ovaries: our experience and perspectives of a new method." Klinicheskaia khirurgiia 87, no. 9-10 (October 29, 2020): 54–58. http://dx.doi.org/10.26779/2522-1396.2020.9-10.54.
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Objective. Studying of results of the cytoreductive operations and hyperthermal intraperitoneal chemoperfusion application for treatment of canceromatosis in colorectal cancer and ovarian cancer.
Materials and methods. In 10 patients, suffering colorectal cancer (6 men and 4 women) were performed peritonectomy, diathermo-ablation of implants, made from visceral peritoneum. Average value of the peritoneal canceromatosis index have constituted 18 (14 - 21). In 11 patients, suffering ovarian cancer, panhisterectomy, peritonectomy, omentectomy, and ablation of the visceral peritoneum implants was conducted. Median value of the peritoneal canceromatosis index was 16 (12 - 20). For hyperthermal intraperitoneal chemoperfusion oxaliplatin was used.
Results. Complete and optimal cytoreduction (degree CC0-CC1 in accordance to classification of P. H. Sugarbaker) was achieved in 5 patients, while suboptimal one (degree CC2) - in 10, and nonoptimal (degree CC3) cytoreduction - in 6 patients. Intraoperative complications were absent. Postoperative complications have occurred in 5 (23.8%) patients: the wound infection, persisting ileus, episode of partial ileus. Of 10 patients, suffering colorectal cancer, 5 died in 9-12 mo. One-year barrier have had survived 45.5% patients. Of 11 women-patients, suffering ovarian cancer, 7 died in 6-24 mo. One-year barrier have had survived 36.4% women-patients.
Conclusion. In patients, suffering colorectal cancer, the survival median was 12 mo, while in the women-patients, suffering ovarian cancer - 18 mo. Cytoreductive operations and hyperthermal intraperitoneal chemoperfusion constitute perspective method for the survival enhancement in patients, suffering canceromatosis, but only if their selection was organized.
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Delga, Berenice, Jean-Marc Classe, Gilles Houvenaeghel, Guillaume Blache, Laura Sabiani, Houssein El Hajj, Nicole Andrieux, and Eric Lambaudie. "30 Years of Experience in the Management of Stage III and IV Epithelial Ovarian Cancer: Impact of Surgical Strategies on Survival." Cancers 12, no. 3 (March 24, 2020): 768. http://dx.doi.org/10.3390/cancers12030768.
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Objective: to analyze the evolution of surgical techniques and strategies, and to determine their influence on the survival of patients with stage III or IV epithelial ovarian cancer (EOC). Methods: a retrospective data analysis was performed in two French tertiary cancer institutes. The analysis included clinical information, cytoreductive outcome (complete, optimal and suboptimal), definitive pathology, Overall Survival (OS), and Progression-Free Survival (PFS). Three surgical strategies were compared: Primary Cytoreductive Surgery (PCS), Interval Cytoreductive Surgery (ICS) after three cycles of Neo-Adjuvant Chemotherapy (NAC), and Final Cytoreductive Surgery (FCS) after at least six cycles of NAC. We analyzed four distinct time intervals: prior to 2000, between 2000 and 2004, between 2005 and 2009, and after 2009. Results: data from 1474 patients managed for International Federation of Gynecology and Obstetrics (FIGO) stages III (80%) or IV (20%) EOC were analyzed. Throughout the four time intervals, the rate of patients who were treated only medically increased significantly (10.1% vs. 22.6% p < 0.001). NAC treatment increased from 20.1% to 52.2% (p < 0.001). Complete resection rate increased from 37% to 66.2% (p < 0.001). Of our study population, 1260 patients (85.5%) underwent surgery. OS was longer in cases of complete cytoreduction (Hazard Ratio (HR) = 2.123 CI 95% [1.816–2.481] p < 0.001) but the surgical strategy itself did not affect median OS. OS was 44.9 months, 50.3 months, and 42 months for PCS, ICS, and FCS, respectively (p = 0.410). After adjusting for surgical strategies (PCS, ICS, and FCS), all patients with complete cytoreduction presented similar OS with no significant difference. However, PFS was three months shorter when FCS was compared to PCS (p < 0.001). Conclusion: In our 30 years’ experience of EOC management, complete resection rate was the only independent factor that significantly improved OS and PFS, regardless of the surgical strategy.
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Axtell, Allison E., Margaret H. Lee, Robert E. Bristow, Sean C. Dowdy, William A. Cliby, Steven Raman, John P. Weaver, et al. "Multi-Institutional Reciprocal Validation Study of Computed Tomography Predictors of Suboptimal Primary Cytoreduction in Patients With Advanced Ovarian Cancer." Journal of Clinical Oncology 25, no. 4 (February 1, 2007): 384–89. http://dx.doi.org/10.1200/jco.2006.07.7800.
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Purpose Identify features on preoperative computed tomography (CT) scans to predict suboptimal primary cytoreduction in patients treated for advanced ovarian cancer in institution A. Reciprocally cross validate the predictors identified with those from two previously published cohorts from institutions B and C. Patients and Methods Preoperative CT scans from patients with stage III/IV epithelial ovarian cancer who underwent primary cytoreduction in institution A between 1999 and 2005 were retrospectively reviewed by radiologists blinded to surgical outcome. Fourteen criteria were assessed. Crossvalidation was performed by applying predictive model A to the patients from cohorts B and C, and reciprocally applying predictive models B and C to cohort A. Results Sixty-five patients from institution A were included. The rate of optimal cytoreduction (≤ 1 cm residual disease) was 78%. Diaphragm disease and large bowel mesentery implants were the only CT predictors of suboptimal cytoreduction on univariate (P < .02) and multivariate analysis (P < .02). In combination (model A), these predictors had a sensitivity of 79%, a specificity of 75%, and an accuracy of 77% for suboptimal cytoreduction. When model A was applied to cohorts B and C, accuracy rates dropped to 34% and 64%, respectively. Reciprocally, models B and C had accuracy rates of 93% and 79% in their original cohorts, which fell to 74% and 48% in cohort A. Conclusion The high accuracy rates of CT predictors of suboptimal cytoreduction in the original cohorts could not be confirmed in the cross validation. Preoperative CT predictors should be used with caution when deciding between surgical cytoreduction and neoadjuvant chemotherapy.