Some Patients Benefit from Secondary Cytoreductive Surgery for Ovarian Cancer

Some Patients Benefit from Secondary Cytoreductive Surgery for Ovarian Cancer

According to a recent article published in the British Journal of Cancer, specific patient characteristics have been identified that indicate which patients with ovarian cancer appear to benefit from secondary cytoreductive surgery.

Ovarian cancer is a malignancy that arises from various different cells within the ovaries. Approximately 25,000 new cases of ovarian cancer are diagnosed in the United States each year. Standard treatment for ovarian cancer is dependent upon the extent of spread of the cancer, but typically consists of the surgical removal of as much of the cancer as possible, referred to as cytoreductive surgery, as well as chemotherapy and/or radiation therapy. The value of a second cytoreductive surgery in patients with ovarian cancer that has recurred following initial therapy has remained controversial; however, studies have indicated that secondary cytoreductive surgery does not improve outcomes of these patients. These studies did not attempt to determine if specific patient characteristics related to different outcomes following secondary cytoreductive surgery.

Researchers from Japan recently conducted a study to evaluate different patient characteristics and determine if an association existed between these characteristics and outcomes of the patients. This study included 44 patients with recurrent ovarian cancer. All patients underwent secondary cytoreductive surgery between 1987 and 2000. Overall, nearly 60% of patients had all visible cancer removed during their secondary cytoreductive surgery. Outcomes of patients following secondary cytoreductive surgery were related to specific characteristics that were present prior to their recurrence. Patients had significantly improved survival following their secondary cytoreductive surgery if they had a cancer-free time period following initial therapy of greater than 12 months, if they had no cancer spread to the liver (liver metastasis), if they had just one tumor, and if the tumor size was less than 6 centimeters. Patients with 3 or 4 of these characteristics had an average duration of survival of 47 months compared to only 20 months for patients with 1 or 2 of the favorable characteristics. Even patients whose cancer was not completely visibly removed during secondary cytoreductive surgery had an average duration of survival of 40 months if they had 3 or 4 of these characteristics prior to their cancer recurrence.

The researchers concluded that ovarian cancer patients who had a cancer-free time interval following initial therapy of greater than 12 months, no liver metastasis, and just one tumor less than 6 centimeters prior to a cancer recurrence may gain a survival benefit from secondary cytoreductive surgery. Patients with 3 or 4 of these favorable characteristics may wish to speak with their physician about their individual risks and benefits of secondary cytoreductive surgery.

Reference: Onda T, Yoshikawa H, Yasugi T, et al. Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: proposal for patients selection. British Journal of Cancer. 2005; 92, 1026-1032.

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