title: Abdominopelvic cytoreduction rates and recurrence sites in stage IV ovarian cancer: is there a case for thoracic cytoreduction?
abstract: OBJECTIVE
  We report the rates of optimal abdominopelvic cytoreduction and the sites of recurrence in stage IV ovarian cancer patients, with particular attention to the potential impact of thoracic cytoreduction on treatment results in patients with intra-thoracic spread.
  
  
  METHODS
  A historic cohort study of all stage IV ovarian cancer patients diagnosed between 1994 and 2010 and underwent abdominopelvic cytoreductive surgery. Controls were stage IIIc patients. Statistical analyses included χ(2) test, Cox proportional hazards regression models and Kaplan-Meier curves with log-rank tests.
  
  
  RESULTS
  Group 1 included 76 stage IV patients, 55% with thoracic spread. Group 2 included 142 stage IIIc patients. Age, histology, primary peritoneal tumor and ascites rates were similar for the two groups. Respective rates of optimal abdominopelvic cytoreduction were 68% vs. 83.5% (p<0.05), median time to progression 5.3 vs. 12.3 months (p<0.01) and overall survival 27.2 vs. 46.1 months (p<0.01). Optimal cytoreduction and survival rates were similar for all group 1 patients regardless of spread location. Sites of recurrence in stage IV were abdomen (59.3%), thorax (6.8%), both (28.8%) or other (5.1%). The four patients with thoracic recurrence alone were all initially diagnosed with malignant pleural effusion. Three of them developed abdominal recurrence within 15‒6 months.
  
  
  CONCLUSIONS
  Optimal abdominopelvic cytoreduction was achievable in stage IV patients, although in significantly fewer patients than in stage IIIc. Sites of recurrence were rarely thorax alone, implying that thoracic debulking is likely to change the course of disease in only few patients and thus should be carefully individualized.
authors.affiliation: Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Ramat-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel. Electronic address: tamarperri@gmail.com.
authors.forename: Tamar
authors.initials: T
authors.lastname: Perri
authors.forename: Gilad
authors.initials: G
authors.lastname: Ben-Baruch
authors.forename: Sarit
authors.initials: S
authors.lastname: Kalfon
authors.forename: Mario E
authors.initials: ME
authors.lastname: Beiner
authors.forename: Limor
authors.initials: L
authors.lastname: Helpman
authors.forename: Liat Ben-David
authors.initials: LB
authors.lastname: Hogen
authors.forename: Ronnie
authors.initials: R
authors.lastname: Shapira-Frommer
authors.forename: Jacob
authors.initials: J
authors.lastname: Korach
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000097:blood; D002277:Carcinoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005185:Fallopian Tube Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000601:surgery*; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013909:Thorax / Q000473:pathology
chemical_list: D018394:CA-125 Antigen
keywords: Advanced; Cytoreduction; Ovarian cancer; Recurrence site; Thorax