A Ferrero1, A Ditto2, G Giorda3, A Gadducci4, S Greggi5, A Daniele6, L Fuso7, E Panuccio8, C Scaffa5, F Raspagliesi9, P Sismondi10, N Biglia11. 1. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: a.ferrero@katamail.com. 2. Department of Gynecological Oncology, National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, Italy. Electronic address: antonino.ditto@istitutotumori.mi.it. 3. Department of Gynecological Oncology, Comprehensive Cancer Centre of Aviano, Via Franco Gallini, 2, 33081 Aviano, PN, Italy. Electronic address: giorgio.giorda@tin.it. 4. Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Azienda Ospedaliero Universitaria Pisana, Via Roma, 67, 56100 Pisa, Italy. Electronic address: a.gadducci@med.unipi.it. 5. Department of Gynecological Oncology, National Cancer Institute of Napoli, Via Mariano Semmola, 80131 Napoli, Italy. Electronic address: oncogin03@yahoo.it. 6. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: albertodaniele@hotmail.it. 7. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: lfuso@mauriziano.it. 8. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: ucciopan@gmail.com. 9. Department of Gynecological Oncology, National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, Italy. Electronic address: francesco.raspagliesi@istitutotumori.mi.it. 10. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: piero.sismondi@unito.it. 11. Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy. Electronic address: nicoletta.biglia@unito.it.
Abstract
INTRODUCTION: Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes. PATIENTS AND METHODS: We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected. RESULTS: Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%. CONCLUSIONS: Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.
INTRODUCTION: Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes. PATIENTS AND METHODS: We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected. RESULTS: Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%. CONCLUSIONS: Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.
Authors: Robert L Hollis; Juliet Carmichael; Alison M Meynert; Michael Churchman; Amelia Hallas-Potts; Tzyvia Rye; Melanie MacKean; Fiona Nussey; Colin A Semple; C Simon Herrington; Charlie Gourley Journal: Am J Obstet Gynecol Date: 2019-05-02 Impact factor: 8.661
Authors: Reitan Ribeiro; João A Guerreiro; Murilo A Luz; Jeferson L Mattana; Maurício Zapparoli; William Kondo Journal: Gynecol Oncol Rep Date: 2015-10-13