Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: Who benefits?

BACKGROUND. This study was performed to address patient selection criteria and the role of secondary cytoreductive surgery (SCR) in patients with epithelial ovarian carcinoma (EOC) who had relapsed tumors after a progression-free interval greater than or equal to 3 months. METHODS. One hundred seventeen patients with relapsed EOC after a clinical complete remission duration greater than or equal to 3 months who underwent SCR were entered on N. this prospective trial. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using log-rank tests, logistic stepwise regression analyses, and a Cox stepwise regression model. RESULTS. The median patient age at the time of relapse was 53 years (range, 20-78 years). The median survival was 22 months and the estimated 5-year survival rate for the entire cohort was 17.2%. Tumor was confined to a solitary site in 33 patients and to greater than or equal to 2 sites in 84 patients. After they underwent SCR, 11 patients were rendered macroscopically disease free, 61 patients had residual disease that measured less than or equal to 1 cm in greatest dimension, and 45 patients had bulky intraabdominal residual disease. Survival was influenced by the extent of relapse disease (solitary site vs. multiple sites; P < 0.0001), the size of residual disease after SCR (0 cm vs. 1 cm [P = 0.1211], less than or equal to 1 cm vs. > 1 cm [P = 0.0002], and 0 cm vs. > 1 cm [P 0.0011]), Eastern Cooperative Oncology Group performance status (0 vs. 1 [P 0.134], 1 vs. 2 [P = 0.007], and 0 vs. 2 [P - 0.0012]), and the number of cycles of salvage chemotherapy (1-2 cycles vs. 3-5 cycles [P = 0.0144]; 1-2 cycles vs. greater than or equal to 6 cycles [P < 0.0001]; and 3-5 cycles vs. 6 cycles [P = 0.0009]). The outcome of SCR was influenced by the extent of relapse disease (multiple sites [51.2%] vs. solitary sites [87.9%]; relative risk [RR] 9.1237; P = 0.0002) and by the use of bowel resection (yes [60.9%] vs. no [37.5%]; RR = 0.3828; P = 0.0106). CONCLUSIONS. SCR was found to be safe for patients with relapsed EOC who achieved a clinical complete remission that lasted 3 months, with resectability similar to that of primary debulking surgery. Optimal surgical outcomes were achieved easily in patients who apparently had solitary tumor sites, with bowel resection making it possible to remove bulky tumors that involved the intestine. A survival benefit was provided by optimal SCR, particularly when surgery was supported by multiple courses of salvage chemotherapy. @ 2004 American Cancer Society.