Claudia Marchetti1, Anna Fagotti1,2, Vincenzo Tombolini3, Giovanni Scambia1,2, Francesca De Felice4. 1. Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 2. Catholic University of the Sacred Heart, Rome, Italy. 3. Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. 4. Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy. fradefelice@hotmail.it.
Abstract
BACKGROUND: Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. METHODS: The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. RESULTS: Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61-0.78; p < 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48-0.66; p < 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78-1.10; p = 0.37), but it was 0.73 (95% CI, 0.59-0.91) in favor of the complete resection subpopulation. CONCLUSION: This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
BACKGROUND: Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. METHODS: The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. RESULTS: Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61-0.78; p < 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48-0.66; p < 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78-1.10; p = 0.37), but it was 0.73 (95% CI, 0.59-0.91) in favor of the complete resection subpopulation. CONCLUSION: This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
Authors: Robert L Dood; Yang Zhao; Shannon D Armbruster; Robert L Coleman; Shelley Tworoger; Anil K Sood; Keith A Baggerly Journal: JAMA Oncol Date: 2018-11-01 Impact factor: 31.777
Authors: Robert L Coleman; Nick M Spirtos; Danielle Enserro; Thomas J Herzog; Paul Sabbatini; Deborah K Armstrong; Jae-Weon Kim; Sang-Yoon Park; Byoung-Gie Kim; Joo-Hyun Nam; Keiichi Fujiwara; Joan L Walker; Ann C Casey; Angeles Alvarez Secord; Steve Rubin; John K Chan; Paul DiSilvestro; Susan A Davidson; David E Cohn; Krishnansu S Tewari; Karen Basen-Engquist; Helen Q Huang; Mark F Brady; Robert S Mannel Journal: N Engl J Med Date: 2019-11-14 Impact factor: 91.245