Critical evaluation of secondary cytoreduction in recurrent ovarian cancer.
OBJECTIVE
The optimal strategy for salvage therapy in patients who suffer from ovarian cancer recurrence after a disease-free interval is not established. The objective of this paper is to analyze the existing published data on salvage surgery in this setting.


METHODS
A retrospective review of the English literature was done looking at studies addressing the role of secondary cytoreductive surgery in recurrent ovarian cancer. A number of parameters were collected from these studies and analyzed, including patients' characteristics, outcome of secondary cytoreduction, perioperative complications, postoperative therapy, and survival. In a parallel analysis, we reviewed the outcome of patients treated with salvage chemotherapy without surgery in similar clinical settings.


RESULTS
Optimal cytoreduction was achievable in 38-87% of the study populations reviewed with acceptable perioperative complications and mortality. The attempt to analyze the impact of secondary cytoreduction on survival was limited by (1) the inter-investigator differences in defining optimal cytoreduction, (2) the heterogeneity of the patients included, (3) and the lack of information on postoperative therapy. All the studies suggest that patients left with no gross residual disease after secondary cytoreduction seem to benefit from prolonged survival in the range of 44-60 months. Current data reveal that the use of combination chemotherapy without surgery for salvage treatment of recurrent ovarian cancer can be associated with prolonged median survival reaching up to 35 months.


CONCLUSIONS
The available data suggest a benefit for secondary surgical cytoreduction in recurrent ovarian cancer. This needs to be considered in the light of recent data reporting prolonged survival with the use of combination salvage chemotherapy without surgery. Currently, it is not known if a salvage strategy combining surgery and multiagent chemotherapy regimens will have a survival benefit over chemotherapy alone. Hopefully, current ongoing prospective trials will answer this question.
Munkarah
A R
AR
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wayne State University, Karmanos Cancer Institute, Detroit, MI 48201, USA. amunkara@med.wayne.edu <amunkara@med.wayne.edu>
Coleman
R L
RL
D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy