Does secondary surgical cytoreduction improve survival in women with advanced ovarian cancer?

Adnan Munkarah

This article has no abstract so we have provided the first paragraph of the full text.

In 1995, a study by the European Organization for Research and Treatment of Cancer (EORTC) evaluated the role of debulking surgery after induction chemotherapy in patients with advanced epithelial ovarian cancer. The findings suggested that interval debulking significantly lengthened progression-free and overall survival in a group of patients who had bulky disease at the time induction chemotherapy was initiated. Critics of the EORTC study raised two points. First, the trial did not require a maximal surgical effort at the time of primary surgery. Second, it was conducted during a time period when taxanes were not commonly used as an integral part of the primary chemotherapy regimens. The GOG study by Rose et al. was designed to address these points. The results suggest that secondary cytoreduction does not provide any survival advantage in ovarian cancer patients who had undergone an aggressive yet suboptimal primary cytoreduction followed by a chemotherapy regimen of paclitaxel and cisplatin. One important prognostic factor noted in the study was the tumor size prior to secondary surgery. Patients with tumor exceeding 1 cm in diameter prior to secondary cytoreduction had a death rate that was 71% higher than that of patients with tumors of 1 cm or less. This is concordant with findings from the EORTC study and suggests that a good response to chemotherapy, an optimal 'chemodebulking', is associated with improved survival. This may be a reflection of a favorable tumor biology and high chemosensitivity.

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