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2022-RA-276-ESGO Value of surgical cytoreduction for subsequent ovarian cancer relapse in patients previously treated with chemotherapy alone at 1st-relapse: a subanalysis of the DESKTOP III/ENGOT-ov20 trial
  1. Christina Fotopoulou1,
  2. Jalid Sehouli2,
  3. Ignace Vergote3,
  4. Alexander Reuss4,
  5. Marianne Leheurteur5,
  6. Felix Hilpert6,
  7. Aude-Marie Savoye7,
  8. Stefano Greggi8,
  9. Johanna Vernersson9,
  10. Benoît Resch10,
  11. Michel Gatineau11,
  12. Jean Levêque12,
  13. Rongyu Zang13,
  14. Pernille T Jensen14,
  15. Jae W Kim15,
  16. Domingo Santiago16,
  17. Francesco Raspagliesi17,
  18. Ulla Peen18,
  19. Andreas du Bois19 and
  20. Philipp Harter19
  1. 1AGO and Imperial College, London, UK
  2. 2AGO and Campus Virchow, Charité, Berlin, Germany
  3. 3BGOG and University Hospitals Leuven, Leuven, Belgium
  4. 4Coordinating Center for Clinical Trials, AGO and Philipps-University Marburg, Marburg, Germany
  5. 5GINECO and Centre Henri Becquerel, Rouen, France
  6. 6AGO and Onkologisches Therapiezentrum Krankenhaus Jerusalem, Hamburg, and UKSH Kiel, Hamburg, Germany
  7. 7GINECO and Institut Jean Godinot, Reims, France
  8. 8MITO and Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Milano, Italy
  9. 9NSGO-CTU and Karolinska University Hospital, Clinical Trials Unit Solna, Solna, Sweden
  10. 10GINECO and CHU de Rouen, Rouen, France
  11. 11GINECO and Hôpital St Joseph, Paris, France
  12. 12GINECO and CHU Rennes, Rennes, France
  13. 13SGOG and Fudan University Zhongshan Hospital, Shanghai, China
  14. 14NSGO-CTU and Odense University Hospital, Gynecology and Obstetrics, and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
  15. 15KGOG and Seoul National University, Seoul, Korea, Republic of
  16. 16GEICO and Hospital Universitari i Politecnic La Fe, Valencia, Spain
  17. 17MITO and Fondazione IRCCS Istituto Nazionale dei Tumori Milan, Milan, Italy
  18. 18NSGO-CTU and Herlev University Hospital, Herlev, Denmark
  19. 19AGO and Ev. Kliniken Essen-Mitte, Essen, Germany


Introduction/Background The DESKTOP III trial has demonstrated a significant survival benefit in AGO-score positive patients who underwent complete cytoreduction at 1st relapse compared to those treated with chemotherapy alone. The question whether eligible patients who missed the opportunity of potentially life prolonging surgery at 1st relapse would benefit from surgery at the time of their second relapse, remains open.

Methodology We evaluated separately the patients who were randomized in the standard, non-surgical arm of the DESKTOP III trial who then subsequently underwent cytoreductive surgery at a subsequent relapse at investigator’s discretion.

Results The median progression-free survival (PFS) counted from randomization of 201 patients in the control arm of DESKTOP III was 14.0 months. 171 (85%) had progressive or relapsing disease and 32 of 171 (19%) underwent cytoreductive surgery. Patients’ median age at this subsequent surgery was 63 years (range: 46 – 78). Complete tumor resection was achieved in 19 patients (60%), while 5 (16%) had postoperative residual disease (n=8 missing data). Sixteen patients (50%) commenced systemic treatment within 90 days from surgery, as documented. Thirty- and 90-day surgical mortality rates were 1 (3%) and 2 (6%), respectively. Within a postoperative median follow-up time of 43.8 months, 12 (38%) deaths were reported. Median overall survival after surgery (OS) was 54.0 months. One- and 2-year OS rates were 91% and 84%, respectively.

Conclusion Cytoreductive surgery for subsequent ovarian cancer relapse appears feasible and with low mortality in selected patients who received non-surgical treatment at 1st relapse despite a positive AGO -score. Surgery could be considered as an option in carefully selected patients also later in their journey within a specialized gynecological cancer setting.

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