BACKGROUND. This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma.
METHODS.
One hundred six patients with a disease free interval (DFI) ΟΎ 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival.
RESULTS.
Eighty-seven patients (82.1%) underwent removal of all visible tumor.
The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (Ο½ 10 cm [90.0%] vs. ΟΎ 10 cm [66.7%]; P Ο 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given [64.3%] vs. chemotherapy not given [93.8%]; P Ο 0.001), and preoperative Gynecologic Oncology Group performance status (0 [100%], 1 [91.4%], 2 [82.4%], and 3 [47.4%]; P Ο 0.001). Survival was influenced by the DFI after primary treatment (6 -12 months [median, 25.0 months] vs. 13-36 months [median, 44.4 months] vs. ΟΎ 36 months [median, 56.8 months]; P Ο 0.005), the completeness of cytoreduction (visibly disease free [median, 44.4 months] vs. any residual disease [median, 19.3 months]; P Ο 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given [median, 24.9 months] vs. chemotherapy not given [median, 48.4 months]; P Ο 0.005), and the largest size of recurrent tumor (Ο½ 10 cm [median, 37.3 months] vs. ΟΎ 10 cm [median, 35.6 months]; P Ο 0.04]).
CONCLUSIONS.
Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.