title: Secondary surgical cytoreduction for advanced ovarian carcinoma.
abstract: BACKGROUND
  We evaluated the effect of adding secondary cytoreductive surgery to postoperative chemotherapy on progression-free survival and overall survival among patients who had advanced ovarian cancer and residual tumor exceeding 1 cm in diameter after primary surgery.
  
  
  METHODS
  Women were enrolled within six weeks after primary surgery. If, after three cycles of postoperative paclitaxel plus cisplatin, a patient had no evidence of progressive disease, she was randomly assigned to undergo secondary cytoreductive surgery followed by three more cycles of chemotherapy or three more cycles of chemotherapy alone.
  
  
  RESULTS
  We enrolled 550 women. After completing three cycles of postoperative chemotherapy, 216 eligible patients were randomly assigned to receive secondary surgical cytoreduction followed by chemotherapy and 208 to receive chemotherapy alone. Surgery was declined by or medically contraindicated in 15 patients who were assigned to secondary surgery (7 percent). As of March 2003, 296 patients had died and 82 had progressive disease. The likelihood of progression-free survival in the group assigned to secondary surgery plus chemotherapy, as compared with the chemotherapy-alone group, was 1.07 (95 percent confidence interval, 0.87 to 1.31; P=0.54), and the relative risk of death was 0.99 (95 percent confidence interval, 0.79 to 1.24; P=0.92).
  
  
  CONCLUSIONS
  For patients with advanced ovarian carcinoma in whom primary cytoreductive surgery was considered to be maximal, the addition of secondary cytoreductive surgery to postoperative chemotherapy with paclitaxel plus cisplatin does not improve progression-free survival or overall survival.
authors.affiliation: Case Western Reserve University and the Division of Gynecologic Oncology, MetroHealth Medical Center, Cleveland, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: Stacy
authors.initials: S
authors.lastname: Nerenstone
authors.forename: Mark F
authors.initials: MF
authors.lastname: Brady
authors.forename: Daniel
authors.initials: D
authors.lastname: Clarke-Pearson
authors.forename: George
authors.initials: G
authors.lastname: Olt
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Rubin
authors.forename: David H
authors.initials: DH
authors.lastname: Moore
authors.forename: James M
authors.initials: JM
authors.lastname: Small
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D011183:Postoperative Complications; D016019:Survival Analysis
chemical_list: D017239:Paclitaxel; D002945:Cisplatin