Elsevier

Gynecologic Oncology

Volume 136, Issue 1, January 2015, Pages 25-29
Gynecologic Oncology

The role of secondary cytoreduction in low-grade serous ovarian cancer or peritoneal cancer

https://doi.org/10.1016/j.ygyno.2014.11.005Get rights and content

Highlights

  • SCRS to no gross residual yielded longer PFS and OS than SCRS with gross residual.

  • PFS was longer in women who proceeded directly to SCRS vs treatment first then SCRS.

  • SCRS should be considered in select patients with recurrent disease.

Abstract

Objectives

We sought to determine the benefit of secondary cytoreductive surgery (SCRS) in patients with low-grade serous ovarian or peritoneal carcinoma, and whether cytoreduction to no gross residual disease affects survival.

Methods

A single institution retrospective chart review was conducted in patients with recurrent low-grade serous carcinoma who underwent SCRS between 1995 and 2012. Data including demographics, survival, chemotherapy, disease characteristics at the time of surgery, residual disease, and operative complications were collected. Overall survival (OS) and progression-free survival (PFS) were calculated. Kaplan–Meier and log-rank tests were used to examine survival outcomes.

Results

Forty-one patients met inclusion criteria. The median time between primary tumor debulking and SCRS was 33.2 months. Of 41 eligible patients who underwent SCRS, 32 (78%) had gross residual disease at the completion of secondary surgery. The median PFS for patients with no gross residual disease after SCRS was 60.3 months, compared to 10.7 months for patients with gross residual disease (p = 0.008). Median OS from diagnosis for patients with no gross residual disease after SCRS was 167.5 months compared to 88.9 months (p = 0.10). Median OS from the time of SCRS for patients with no gross residual disease was 93.6 months compared to 45.8 months (p = 0.04). Complications occurred in 61% of patients after SCRS; there were no deaths directly attributable to surgery.

Conclusion

Our results suggest a benefit to SCRS in patients with recurrent low-grade serous carcinoma. Efforts to maximally cytoreduce patients should be made as patients with no gross residual disease had a better PFS and a trend toward better OS.

Introduction

High-grade serous ovarian carcinomas comprise the majority of the estimated 22,000 new cases of ovarian cancer per year in the United States [1]. Low-grade serous carcinoma constitutes a smaller (5–10%), yet significant proportion of serous carcinoma cases [2], [3]. It is accepted that high-grade and low-grade serous carcinoma arise from molecularly discrete pathways and exhibit divergent clinical behavior [4], [5], [6], [7]. For example, while the overall five-year survival for patients with low-grade SOC is longer compared to high-grade serous carcinoma [8], low-grade serous carcinomas are relatively chemoresistant [9], [10]. Emerging targeted therapies have shown promise in low-grade serous carcinoma [11]; however, the role of secondary surgery remains unclear.

In the setting of recurrent high-grade serous carcinoma, most patients are offered chemotherapy or hormonal therapy, and a small subset of patients may benefit from secondary cytoreductive surgery (SCRS). Retrospective reviews suggest that secondary cytoreduction confers a survival advantage in a highly-selected group of patients with recurrent epithelial histology, particularly patients with platinum-sensitive disease with a single site of recurrence [12], [13]. Ongoing prospective clinical trials such as GOG 213 are attempting to more clearly define the role of secondary cytoreduction [14]. While some studies have included low-grade serous histology [15], none have specifically focused on secondary cytoreduction in this particular patient population. We therefore sought to determine the benefit of secondary cytoreduction in low-grade serous carcinoma, whether cytoreduction to no gross residual disease had an impact on progression-free and overall survival (PFS, OS), and whether certain patient characteristics could identify ideal candidates for SCRS.

Section snippets

Methods

After obtaining approval from the Institutional Review Board at the University of Texas MD Anderson Cancer Center, women with a diagnosis of low-grade serous carcinoma who underwent secondary cytoreduction for disease progression/recurrence between 1995 and 2011 were identified. Patients who met the following inclusion criteria were selected: 1) pathologically confirmed low-grade serous histology at the time of initial and secondary cytoreduction, 2) SCRS performed at MD Anderson Cancer Center,

Results

A total of 41 patients who met inclusion criteria comprised our study cohort. Table 1 displays patient characteristics. Median age at time of initial diagnosis was 41.3 years (range 21–74). Six patients (14.6%) were initially diagnosed with serous LMP tumors prior to their diagnosis of low-grade serous carcinoma; the remaining 35 (85.4%) had low-grade serous carcinoma at the time of initial diagnosis. Most patients were White (76%), and most patients (85.4%) had FIGO stage III or IV disease.

At

Discussion

This study demonstrates that patients with low-grade serous carcinoma who underwent secondary cytoreductive surgery to no gross residual disease experienced a 50-month gain in PFS and a 47.8-month gain in OS from the time of SCRS compared to patients with gross residual disease.

Our findings mirror that of other studies examining SCRS in epithelial ovarian cancer, most of which are comprised of high-grade serous histology. Al Rawahi et al. performed a meta-analysis on 1194 women who underwent

Conflict of interest statement

The authors of this manuscript declare no conflicts of interest.

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    This work was supported in part by NCI-DHHS-NIH T32 Training Grant (T32 CA101642) (EKC) and by The Sara Brown Musselman Fund for Serous Ovarian Cancer Research.

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