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Aggressive surgery doesn’t necessarily improve survival from advanced ovarian cancer

Key clinical point: Both overall survival and progression-free survival were significantly improved when complete resection was achieved, but not when there was minimal residual tumor.

Data source: A retrospective secondary analysis of survival data in a subgroup of 2,655 women enrolled in a cohort study of advanced epithelial ovarian cancer.

Disclosures: This study was supported by the National Cancer Institute. Dr. Horowitz and his associates reported having no financial disclosures.


 

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For women with advanced epithelial ovarian cancer, aggressive cytoreductive surgery improves survival only if complete resection of disease is achieved. Aggressive debulking that achieves anything less than complete resection (R0) – even if the residual tumor is minimal (< 1 cm) – will not improve survival, according to a report published online Feb. 9 in Journal of Clinical Oncology.

“Over the last decade, there has been a growing trend toward more aggressive primary debulking surgery for women with epithelial ovarian cancer,” even though the impact of this approach on survival “has been unclear.” To examine the issue, researchers analyzed data from the multicenter Gynecologic Oncology Group-182 cohort, which they described as the largest clinical trial of ovarian cancer to date. They assessed survival outcomes in 2,655 patients who underwent aggressive cytoreductive surgery before receiving chemotherapy. The resection was complete (R0), in 32.4% of the women; it left minimal residual tumor (< 1 cm) in the remaining 67.6%, said Dr. Neil S. Horowitz of Brigham and Women’s Hospital, Boston, and his associates.

Both overall survival and progression-free survival were significantly improved when R0 was achieved, but not when there was minimal residual tumor. In the literature, as many as 25% of women who undergo aggressive surgical cytoreduction experience significant postoperative morbidity, and up to 2% fail to survive the procedure. These findings therefore “suggest that complex surgical procedures should be selectively used in patients with significant disease distribution and limited to those where only microscopic residual can be achieved,” the investigators said (J. Clin. Oncol. 2015 Feb. 9 [doi: 10.1200/JCO.2014.56.3106]).

“We suggest a potential paradigm shift, in which, if R0 is difficult to attain at primary cytoreduction, use of neoadjuvant chemotherapy with interval debulking to allow for R0 may be superior to primary surgery after which the patient is left with gross residual disease,” Dr. Horowitz and his associates added.

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