PURPOSE: Studies indicate that ovarian cancer patients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice. PATIENTS AND METHODS: One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model. RESULTS: There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked (< or = 2 cm residual disease) than UK patients [corrected] (71.3% v 58.4%, respectively; P < .001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy. CONCLUSION: Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients.
RCT Entities:
PURPOSE: Studies indicate that ovarian cancerpatients who have been optimally debulked survive longer. Although chemotherapy has been variable, they have defined standards of care. Additionally, it is suggested that patients from the United Kingdom (UK) have inferior survival compared with some other countries. We explored this within the context of a large, international, prospective, randomized trial of first-line chemotherapy in advanced ovarian cancer (docetaxel-carboplatin v paclitaxel-carboplatin; SCOTROC-1). The Scottish Randomised Trial in Ovarian Cancer surgical study is a prospective observational study examining the impact on progression-free survival (PFS) of cytoreductive surgery and international variations in surgical practice. PATIENTS AND METHODS: One thousand seventy-seven patients were recruited (UK, n = 689; Europe, United States, and Australasia, n = 388). Surgical data were available for 889 patients. These data were analyzed within a Cox model. RESULTS: There were three main observations. First, more extensive surgery was performed in non-UK patients, who were more likely to be optimally debulked (< or = 2 cm residual disease) than UK patients [corrected] (71.3% v 58.4%, respectively; P < .001). Second, optimal debulking was associated with increased PFS mainly for patients with less extensive disease at the outset (test for interaction, P = .003). Third, UK patients with no visible residual disease had a less favorable PFS compared with patients recruited from non-UK centers who were similarly debulked (hazard ratio = 1.85; 95% CI, 1.16 to 2.97; P = .010). This observation seems to be related to surgical practice, primarily lymphadenectomy. CONCLUSION: Increased PFS associated with optimal surgery is limited to patients with less advanced disease, arguing for case selection rather than aggressive debulking in all patients irrespective of disease extent. Lymphadenectomy may have beneficial effects on PFS in optimally debulked patients.
Authors: Neil S Horowitz; Austin Miller; Bunja Rungruang; Scott D Richard; Noah Rodriguez; Michael A Bookman; Chad A Hamilton; Thomas C Krivak; G Larry Maxwell Journal: J Clin Oncol Date: 2015-02-09 Impact factor: 44.544
Authors: C Bachmann; S Bachmann; T Fehm; A Staebler; S Becker; R Rothmund; C Gardanis; E M Grischke; D Wallwiener; E F Solomayer Journal: J Cancer Res Clin Oncol Date: 2011-11-22 Impact factor: 4.553
Authors: Dana M Roque; Natalia Buza; Michelle Glasgow; Stefania Bellone; Ileana Bortolomai; Sara Gasparrini; Emiliano Cocco; Elena Ratner; Dan-Arin Silasi; Masoud Azodi; Thomas J Rutherford; Peter E Schwartz; Alessandro D Santin Journal: Clin Exp Metastasis Date: 2013-09-05 Impact factor: 5.150
Authors: Oliver Zivanovic; Camelia S Sima; Alexia Iasonos; William J Hoskins; Pavani R Pingle; Mario M M Leitao; Yukio Sonoda; Nadeem R Abu-Rustum; Richard R Barakat; Dennis S Chi Journal: Gynecol Oncol Date: 2010-03 Impact factor: 5.482
Authors: Chad A Hamilton; Austin Miller; Caela Miller; Thomas C Krivak; John H Farley; Mildred R Chernofsky; Michael P Stany; G Scott Rose; Maurie Markman; Robert F Ozols; Deborah K Armstrong; G Larry Maxwell Journal: Gynecol Oncol Date: 2011-06-17 Impact factor: 5.482