title: Is There a Role for Tertiary (TCR) and Quaternary (QCR) Cytoreduction in Recurrent Ovarian Cancer?
abstract: BACKGROUND
  The aim of the present study was to evaluate the efficacy of tertiary and quaternary cytoreduction in recurrent ovarian cancer patients.
  
  
  METHODS
  Between January 1997 and December 2014, 53 patients were submitted to cytoreductive surgery for second and third ovarian cancer recurrence at our Unit.
  
  
  RESULTS
  Median age at first diagnosis was 48 years (range=20-69). Forty-six patients (86.8%) underwent tertiary cytoreduction. At the time of surgery, isolated and diffuse disease was observed in 48 (90.6%) and 5 (9.4%) patients, respectively. Complete and optimal cytoreduction was obtained in 41 (77.5%) and in 1 (1.9%) patients, respectively. We did not observe any statistically significant survival differences according to residual tumor. Patients with TFI >12 months showed longer PFS (38 vs. 7 months, p<0.002) than those with TFI <12 months. In 18 of these patients a third recurrence was observed. In 12 patients (66.7%) a complete quaternary cytoreduction was performed. Longer PFS (16 vs. 21 months; p=0.032) and OS (152 vs. 116 months; p=0.015) in patients submitted to cytoreduction with respect to those treated with chemotherapy were observed.
  
  
  CONCLUSIONS
  Our data suggest that selected ovarian cancer patients who develop a secondary and tertiary recurrence may benefit from additional cytoreductive attempts. The benefit seems to be greater in patients with TFI >12 months showing a single-site recurrence disease, in which complete cytoreduction is achievable. Further studies are required to better-define the role of tertiary and quaternary cytoreduction in recurrent ovarian cancer patients.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy francesco.fanfani@rm.unicatt.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Minimally Invasive Gynecology, St. Maria Hospital, University of Perugia, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Gynecologic Oncology Unit, Policlinico Abano Terme, Abano Terme, Padua, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ercoli
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.affiliation: Division of Gynaecologic Oncology, Foundation John Paul II, Campobasso, Italy, Department of Obstetrics and Gynaecology, University of Molise, Campobasso, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", University of Trieste, Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Restaino
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Monterossi
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Hearth, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000601:surgery*; D012086:Reoperation; D016019:Survival Analysis; D055815:Young Adult
keywords: Recurrent ovarian cancer; quaternary cytoreduction; tertiary cytoreduction