Mayo Clinic Finds Aggressive Surgery Best Option For Advanced-s...

Kudos on the Mayo Clinic Cancer Center study of aggressive surgery being the best option for advanced-stage ovarian cancer patients.

Patients with ovarian cancer should undergo aggressive de-bulking surgery up front, prior to chemotherapy. It has long been observed that those patients whose tumors can be resected without any visible residual disease tend to live longer than those who are left with residual tumor after de-bulking surgery. Based upon this, up front, de-bulking surgery has become the standard of care.

Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive.

Surgery is an integral part of the multimodality treatment of many cancers. In the case of ovarian cancer, proper patient selection will ensure the benefit of surgery for those who need it and avoid its morbidity and delay in the commencement of chemotherapy for those who are unlikely to benefit from it.

Surgery May Improve Survival Compared to Chemotherapy in Patients with Recurrent Ovarian Cancer

According to a recent article in Gynecologic Oncology, patients with recurrent ovarian cancer may have improved survival when treated with cytoreductive surgery compared to chemotherapy alone. However, patients who can have all of their visible cancer removed during surgery appear to gain the most benefit.

Ovarian cancer is a malignancy that arises from various different cells within the ovaries. Approximately 25,000 new cases of ovarian cancer are diagnosed in the Unitred States each year. Standard treatment for ovarian cancer is dependent upon the extent of spread of the cancer, but typically consists of the surgical removal of as much of the cancer as possible, referred to as cytoreductive surgery, as well as chemotherapy and/or radiation therapy. The value of a second cytoreductive surgery in patients with ovarian cancer that has recurred following initial therapy has remained controversial, as some studies have indicated that secondary cytoreductive surgery does not improve outcomes of these patients, while other studies have indicated that patients with specific disease characteristics may have improved long-term outcomes from secondary cytoreductive surgery. Studies are ongoing in an attempt to answer questions surrounding the possible benefits of secondary cytoreductive surgery in patients with recurrent ovarian cancer.

Researchers from Turkey recently conducted a clinical study to further evaluate the role of secondary cytoreductive surgery in patients with ovarian cancer. This study included 75 patients with recurrent ovarian cancer, 44 of whom underwent surgery to remove as much of the cancer as possible, and 31 of whom underwent chemotherapy for their recurrent disease. All patients had remained cancer-free for at least 6 months following their initial therapy. Overall, patients who underwent surgery for their recurrence had a significantly increased duration of survival compared to those treated with chemotherapy for their recurrence. Furthermore, patients who were able to have all of their visible cancer removed during surgery (77% in this study) had a significantly improved duration of survival compared to those who were not able to have all of their cancer surgically removed.

The researchers concluded that cytoreductive surgery may improve survival compared to chemotherapy alone in patients with recurrent ovarian cancer. Patients whose cancer is completely removed appear to achieve the greatest benefit from surgery. Future clinical trials are necessary to help determine specific patient and disease characteristics that are associated with optimal outcomes with cytoreductive surgery. Surgery will also have to be compared to alternative therapy in a randomized phase III trial before this concept is fully accepted. Patients with recurrent ovarian cancer may wish to speak with their physician regarding their individual risks and benefits of treatment with a second cytoreductive surgery.

Reference: Güngör M, Ortac F, Arvas M, et al. The role of secondary cytoreductive surgery for recurrent ovarian cancer. Gynecologic Oncology 2005; 97: 74-79.