Surgical treatment of recurrent ovarian cancer: A review

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Aim. To analyze the data available in the modern literature on the role of repeated cytoreduction in the complex treatment of relapses ovarian cancer (OC).

Materials and methods. Sources were searched in the following systems Clinicaltrials.gov, PubMed, Medline, NCCN, Scopus, Gynecol Oncol, Elibrary. After analyzing the literature review, 31 sources were used, published from January 1989 to December 2020.

Results. The main method of treatment relapses of ОС is administration of systemic chemotherapy. The role of surgical treatment has been actively discussed for several decades. According to the available data of retrospective, prospective, randomized trials, performing surgery following chemotherapy had a favorable effect on the long-term results of treatment just in case of achieving complete cytoreduction in comparison with only chemotherapeutic treatment of platinum-sensitive recurrence of ОС. A validated prognostic model helps to perform the selection of suitable patients for surgical treatment, therefore, the correct selection for secondary cytoreduction allows to identify the patients with a high chance of achieving сomplete cytoreduction, which reduces the number of ineffective operations in patients with residual tumors.

Conclusion. Complete cytoreduction of all macroscopically detectable recurrent tumor lesions in combination with subsequent systemic chemotherapy leads to an improvement in progression-free survival and life expectancy in a carefully selected group of patients with platinum-sensitive recurrent OC. Secondary cytoreduction in platinum-refractory and platinum-resistant relapses deteriorates the prognosis and doesn't lead to an increase in survival rates. Patient selection is the key point in secondary cytoreductive surgery. The choice of the methodology of selection of patients is in the process of discussion. When planning treatment, all patients with recurrent OC should be discussed at multidisciplinary teams with the participation of specialists in related specialties. Considering a surgical treatment option should be performed it in large centers with extensive experience in the surgical treatment of OC, relapses, performing complex multi-organ resections.

About the authors

Omar A. Egenov

Blokhin National Medical Research Center of Oncology

Email: egenov.omar@mail.ru
ORCID iD: 0000-0002-8681-7905

Graduate Student

Russian Federation, Moscow

Ivan S. Stilidi

Blokhin National Medical Research Center of Oncology; Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional Education

Email: egenov.omar@mail.ru
ORCID iD: 0000-0002-0493-1166
SPIN-code: 9622-7106

D. Sci. (Med.), Prof., Acad. RAS

Russian Federation, Moscow

Aleksandra S. Tyulyandina

Blokhin National Medical Research Center of Oncology; Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: egenov.omar@mail.ru
ORCID iD: 0000-0002-6104-7473
SPIN-code: 4848-7126

D. Sci. (Med.)

Russian Federation, Moscow

References

  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.
  2. Wilson MK, Pujade-Lauraine E, Aoki D, et al. Participants of the fifth ovarian cancer consensus conference. Fifth ovarian cancer consensus conference of the gynecologic cancer InterGroup: recurrent disease. Ann Oncol. 2017;28(4):727-32.
  3. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2017;2017(1):7-30. doi: 10.3322/caac.2138767
  4. Тюляндин С.А., Коломиец Л.А., Морхов К.Ю., и др. Практические рекомендации по лечению рака яичников, первичного рака брюшины и рака маточных труб. Злокачественные опухоли. 2020;10(3s2-1):183-95 [Tjuljandin SA, Kolomiec LA, Morhov KJu, et al. Prakticheskie rekomendacii po lecheniju raka jaichnikov, pervichnogo raka brjushiny i raka matochnyh trub. Zlokachestvennye opuholi. 2020;10(3s2-1):183-95 (in Russian)].
  5. Нечушкина В.М., Морхов К.Ю., Тюляндина А.С., и др. Повторные циторедуктивные вмешательства при раке яичников. Злокачественные опухоли. 2018;3s1:42-6 [Nechushkina VM, Morhov KJ, Tjuljandina AS, et al. Povtornye citoreduktivnye vmeshatel'stva pri rake jaichnikov. Zlokachestvennye opuholi. 2018;3s1:42-6 (in Russian)].
  6. Janco JM, Kumar A, Weaver AL, et al. Performance of AGO score for secondary cytoreduction in a high-volume U.S. center. Gynecol Oncol. 2016;141:140-7.
  7. Harter P, du Bois A, Hahmann M, et al. Surgery in recurrent ovarian cancer: the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR trial. Ann Surg Oncol. 2006;13:1702-10.
  8. Tanner EJ, Chi DS, Eisenhauer EL, et al. Surveillance for the detection of recurrent ovarian cancer: survival impact or lead-time bias? Gynecol Oncol. 2010;117:336-40.
  9. Tian WJ, Jiang R, Cheng X, et al. Surgery in recurrent epithelial ovarian cancer: benefits on Survival for patients with residual disease of 0.1–1 cm after secondary cytoreduction. J Surg Oncol. 2010;101:244-50.
  10. Coleman RL, Spirtos NM, Enserro D, et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med. 2019;381(20):1929-39.
  11. Du Bois A, Sehouli J, Vergote I, et al. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: Final analysis of AGO DESKTOP III/ENGOT-ov20. J Clin Oncol. 2020;38(15):6000.
  12. Zang R, Zhu J, Shi T, et al. A randomized phase III trial of secondary cytoreductive surgery in later recurrent ovarian cancer: SOC1/SGOG-OV2. J Clin Oncol. 2020;38(15):6001.
  13. Berek JS, Bertelsen K, Du Bois A, et al. Consensus statements. Ann Oncol. 1999;10(1):S87-S92.
  14. Harter P, Sehouli J, Reuss A, et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: The multicenter intergroup study DESKTOP II. A project of the AGO kommission OVAR, AGO study group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer. 2011;21(2):289-95.
  15. Laas E, Luyckx M, De Cuypere M, et al. Secondary Complete Cytoreduction in Recurrent Ovarian Cancer: Benefit of Optimal Patient Selection Using Scoring System. Int J Gynecol Cancer. 2014;24(2):238-46.
  16. Van De Laar R, Massuger LFAG, Van Gorp T, et al. External validation of two prediction models of complete secondary cytoreductive surgery in patients with recurrent epithelial ovarian cancer. Gynecol Oncol. 2015;137(2):210-5.
  17. Chi DS, McCaughty K, Diaz JP, et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer. 2006;106:1933-9.
  18. Tian W-J, Chi DS, Sehouli J, et al. A Risk Model for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: An Evidence-Based Proposal for Patient Selection. Ann Surg Oncol. 2012;19(2):597-604.
  19. Cowan RA, Eriksson AG, Jaber SM, et al. A comparative analysis of prediction models for complete gross resection in secondary cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2017;145:230-5.
  20. Wagner U, Marth C, Largillier R, et al. Final overall survival results of phase III GCIG CALYPSO trial of pegylated liposomal doxorubicin and carboplatin vs paclitaxel and carboplatin in platinum-sensitive ovarian cancer patients. Br J Cancer. 2012;107(4):588-91.
  21. Aghajanian C, Goff B, Nycum LR, et al. Final overall survival and safety analysis of OCEANS, a phase 3 trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent ovarian cancer. Gynecol Oncol. 2015;139(1):10-6.
  22. Bogani G, Rossetti D, Ditto A, et al. Artificial intelligence weights the importance of factors predicting complete cytoreduction at secondary cytoreductive surgery for recurrent ovarian cancer. J Gynecol Oncol. 2018;29(5):e66.
  23. Bogani G, Tagliabue E, Signorelli M, et al. A score system for complete cytoreduction in selected recurrent ovarian cancer patients undergoing secondary cytoreductive surgery: predictors- and nomogram-based analyses. J Gynecol Oncol. 2018;29(3):e40.
  24. Berek JS, Hacker NF, Lagasse LD, et al. Survival of patients following secondary cytoreductive surgery in ovarian cancer. Obstet Gynecol. 1983;61:189-93.
  25. Morris M, Gershenson DM, Wharton JT. Secondary cytoreductive surgery in epithelial ovarian cancer: nonresponders to first-line therapy. Gynecol Oncol. 1989;33:1-5.
  26. Morris M, Gershenson DM, Wharton JT, et al. Secondary cytoreductive surgery for recurrent epithelial ovarian cancer. Gynecol Oncol. 1989;34:334-8.
  27. Kuhn W, Schmalfeldt B, Pache L, et al. Disease-adapted relapse therapy for ovarian cancer: results of a prospective study. Int J Oncol. 1998;13:57-63.
  28. Jаnicke F, Holscher M, Kuhn W, et al. Radical surgical procedure improves survival time in patients with recurrent ovarian cancer. Cancer. 1992;70:2129-36.
  29. van de Laar R, Kruitwagen RF, IntHout J, et al. Surgery for recurrent epithelial ovarian cancer in the Netherlands: a population-based cohort study. Int J Gynecol Cancer. 2016;26:268-75.
  30. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol. 2009;112(1):265-74.
  31. Al Rawahi T, Lopes AD, Bristow RE, et al. Surgical cytoreduction for recurrent epithelial ovarian cancer. Cochrane Database Syst Rev. February 2013. doi: 10.1002/14651858.CD008765.pub3

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