Long-term follow-up of women with ovarian cancer after positive second-look laparotomy.
OBJECTIVE
Previous reports indicate that cytoreduction and salvage therapy with P32 or whole abdominal radiation may improve survival in patients with positive findings at second-look laparotomy (SLL). The aim of this investigation was to determine whether these findings held true with extended follow-up and a larger patient cohort.


METHODS
From 1977 (the year platinum-based chemotherapy was introduced to our institution) to 1989, 150 patients had persistent disease at SLL. Relevant clinical information was extracted through retrospective chart review.


RESULTS
One hundred forty-five patients were followed until death, with a median follow-up of 15.4 years for the 5 living patients. Median actuarial survival from the time of SLL was 18 months. Tumor grade (P = 0.003) and pre- and post-SLL tumor size (P < 0.0001) were significant determinants of survival by univariate analysis. Patients with microscopic disease or those with < or =1 cm disease rendered microscopic at SLL had improved survival relative to those with < or =1 cm and macroscopic disease following SLL (P = 0.03) (median survivals of 3.3, 2.5, and 1.4 years, respectively). In contrast, median survival of those with >1 cm disease cytoreduced to microscopic disease was no different than those with macroscopic residual, even if < or =1 cm (1.3 and 1.0 years, respectively). After adjusting for tumor size, salvage treatment was not a significant predictor of survival.


CONCLUSIONS
With long-term follow-up there was no suggestion that the type of salvage therapy (e.g., P32 or WART) influenced survival. Rather, low-grade disease and low tumor burdens following cytoreduction were associated with improved survival on multivariate analysis.
Dowdy
Sean C
SC
Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Constantinou
Costas L
CL
Hartmann
Lynn C
LC
Keeney
Gary L
GL
Suman
Vera J
VJ
Hillman
David W
DW
Podratz
Karl C
KC
D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy; D024162:Second-Look Surgery; D015996:Survival Rate; D016896:Treatment Outcome
D009944:Organoplatinum Compounds