F Falcone1, G Scambia2, P Benedetti Panici3, M Signorelli4, G Cormio5, G Giorda6, S Bogliolo7, M Marinaccio8, F Ghezzi9, E Rabaiotti10, E Breda11, G Casella12, F Fanfani2, V Di Donato3, U Leone Roberti Maggiore4, S Greggi13. 1. Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy; Department of Woman, Child, and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. 3. Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy. 4. Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. 5. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy; Gynecologic Oncology Unit, National Cancer Institute, Bari, Italy. 6. Department of Gynecological Oncology, CRO National Cancer Institute, Aviano, Italy. 7. Department of Obstetrics and Gynaecology, IRCCS Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy. 8. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy. 9. Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. 10. Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy. 11. Medical Oncology Unit Ospedale S Giovanni Calibita Fatebenefratelli, Rome, Italy. 12. Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy. 13. Gynecologic Oncology Surgery, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy. Electronic address: s.greggi@istitutotumori.na.it.
Abstract
OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.
OBJECTIVES: To evaluate the impact of tertiary cytoreductive surgery (TCS) on survival in recurrent epithelial ovarian cancer (EOC), and to determine predictors of complete cytoreduction. METHODS: A multi-institutional retrospective study was conducted within the MITO Group on a 5-year observation period. RESULTS: A total of 103 EOC patients with a ≥6month treatment-free interval (TFI) undergoing TCS were included. Complete cytoreduction was achieved in 71 patients (68.9%), with severe post-operative complications in 9.7%, and no cases of mortality within 60days from surgery. Multivariate analysis identified the complete tertiary cytoreduction as the most potent predictor of survival followed by FIGO stage I-II at initial diagnosis, exclusive retroperitoneal recurrence, and TCS performed ≥3years after primary diagnosis. Patients with complete tertiary cytoreduction had a significantly longer overall survival (median OS: 43months, 95% CI 31-58) compared to those with residual tumor (median OS: 33months, 95% CI 28-46; p<0.001). After multivariate adjustment the presence of a single lesion and good (ECOG 0) performance status were the only significant predictors of complete surgical cytoreduction. CONCLUSIONS: This is the only large multicentre study published so far on TCS in EOC with ≥6month TFI. The achievement of postoperative no residual disease is confirmed as the primary objective also in a TCS setting, with significant survival benefit and acceptable morbidity. Accurate patient selection is of utmost importance to have the best chance of complete cytoreduction.
Authors: Marica Garziera; Erika Cecchin; Vincenzo Canzonieri; Roberto Sorio; Giorgio Giorda; Simona Scalone; Elena De Mattia; Rossana Roncato; Sara Gagno; Elena Poletto; Loredana Romanato; Franca Sartor; Jerry Polesel; Giuseppe Toffoli Journal: Int J Mol Sci Date: 2018-05-18 Impact factor: 5.923
Authors: Beryl L Manning-Geist; Dennis S Chi; Kara Long Roche; Oliver Zivanovic; Yukio Sonoda; Ginger J Gardner; Roisin E O'Cearbhaill; Nadeem R Abu-Rustum; Mario M Leitao Journal: Gynecol Oncol Date: 2021-05-25 Impact factor: 5.304