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Residual single-site ovarian cancer surpasses multisite outcomes

 

Key clinical point: Patients with residual ovarian cancer at multiple sites do worse than those with residual cancer at one site.

Major finding: Median overall survival after primary debulking was 64 months with single-site residual disease and 50 months with multisite disease.

Study details: Retrospective review of 510 patients from two U.S. centers.

Disclosures: Dr. Manning-Geist had no disclosures.

Source: Manning-Geist BL et al. SGO 2018, Abstract 43.


 

REPORTING FROM SGO 2018

– When complete resection of advanced-stage, epithelial ovarian cancer is not possible, surgical resection that leaves a small volume of residual tumor at a single site produces significantly better outcomes than leaving minimal residual cancer at multiple sites, according to a review of 510 patients at two U.S. centers.

Dr. Beryl L. Manning-Geist, an ob.gyn. researcher at Brigham and Women's Hospital in Boston Mitchel L. Zoler/MDedge News

Dr. Beryl L. Manning-Geist

“When R0 is not attained, low volume disease – 1 cm or less – confined to a single anatomic location may be an appropriate alternative goal,” Beryl L. Manning-Geist, MD, said at the annual meeting of the Society of Gynecologic Oncology. In contrast, “patients with 1 cm or less of residual disease at multiple anatomic locations have similar oncologic outcomes to suboptimally debulked patients,” those with more than 1 cm of residual tumor remaining at any site, said Dr. Manning-Geist of Brigham and Women’s Hospital in Boston.

“In the past, we separated these patients based on whether they had a complete resection, R0 disease, or had 1 cm or less of residual disease” regardless of the number of sites with this small amount of residual tumor. The third category was patients with more than 1 cm of residual tumor at one or more sites, explained Dr. Manning-Geist in an interview. “What we did was break down the patients with 1 cm or less of residual tumor into those with one site or multiple sites. This is the first reported study to use number of sites” as a clinical characteristic for analysis in this context.

The message from the findings is that, while the goal of debulking surgery in patients with advanced epithelial ovarian cancer is complete tumor resection, if that can’t be achieved, the next goal is to leave residual tumor at just a single site, she concluded. A question that remains is whether primary debulking surgery is preferable to neoadjuvant treatment followed by interval debulking surgery. In the results Dr. Manning-Geist presented, patients who underwent primary debulking had better outcomes than those with neoadjuvant therapy followed by interval debulking, but these two subgroups also had different clinical characteristics.

The study used data from 510 patients with stage IIIC or IV epithelial ovarian cancer treated at either Brigham and Women’s or Massachusetts General Hospital during 2010-2015. The study cohort included 240 patients who underwent primary debulking surgery and 270 who first received neoadjuvant chemotherapy and then underwent interval debulking surgery. The patients who received neoadjuvant therapy were, on average, older (65 years vs. 63 years), had a higher prevalence of stage IV disease (44% vs. 16%), and had a higher prevalence of tumors with serous histology (93% vs. 77%), compared with patients who underwent primary debulking.

Complete tumor resections occurred in 39% of the primary debulking patients and in 64% of those who received neoadjuvant therapy; residual disease of 1 cm or less at one site occurred in 17% and 13%, respectively; minimal residual disease at multiple sites remained in 28% and 17% respectively; and the remaining patients had residual disease of more than 1 cm in at least one site, 16% and 6% respectively.

For this analysis, Dr. Manning-Geist and her associates considered residual disease at any of seven possible sites: diaphragm, upper abdomen, bowel mesentary, bowel serosa, abdominal peritoneum, pelvis, and nodal. Even if multiple individual metastases remained within one of these sites after surgery, it was categorized as a single site of residual disease.

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