Researchers affiliated with Gynecologic Oncology Group (GOG) have reported that patients with more than 5 cm residual disease after surgery have the shortest progression-free (PFS) and overall survivals (OS). The details of this study appeared in an early on-line publication in the Journal of Clinical Oncology on November 19, 2007.

Ovarian cancer is the deadliest of gynecologic cancers. Standard treatment depends upon the stage, or extent of spread of the cancer, but typically consists of surgery, chemotherapy, and/or radiation therapy. A crucial component in achieving optimal survival among patients with ovarian cancer is surgical removal of all or the majority of visible cancer prior to chemotherapy.  Optimal debulking means that only one centimeter or less of visible cancer is left in the body following surgery. Results from studies have indicated that more experienced surgeons provide greater rates of optimal debulking and ultimately improved survival among ovarian cancer patients compared to patients treated in centers where such skills were not available.

The current study evaluated the potential association between extensive surgical removal of cancer and its impact on survival among women with metastatic ovarian cancer. The review consisted of 360 patients who underwent surgery followed by chemotherapy with a platinum compound (Platinol® or Paraplatin®) and Taxol® (paclitaxel). Patients were divided into four groups: those with microscopic disease (0 residual disease), 0.1-1.0 cm of residual disease, 1.0-5 cm of residual disease or >5 cm of residual disease.

• Median progression-free survival was 12 months.
• Median overall survival was 29 months.
• Patients with residual disease greater than 5.0 cm had the shortest PFS and OS.
• Patients with only microscopic residual disease had the best PFS and OS.
• Patients with residual disease of 0.1-1cm and 1.0-5 cm had similar risks of failure as measured by PFS or OS.

The researchers suggested that radical surgical procedures might be indicated for selected patients where “microscopic residual disease is achievable”. They also suggested that “patients with less than 5 cm of disease initially and significant disease and/or co-morbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.”

Comments: The main finding of this study was that they could not distinguish outcomes between patients with 0.1 cm of residual disease with those of up to 5 cm of residual disease. These data should assist surgeons in making decisions about how vigorous to pursue ultraradical surgery in individual patients.

Related News:

Further Evidence Suggesting Survival Associated with Surgeon Experience in Ovarian Cancer (7/2/2007)

Improved Outcomes for Ovarian Cancer Treated by Gynecologic Oncologists (2/3/2006)

Surgical De-bulking Important for Very Elderly with Ovarian Cancer (9/8/2005)

Lymphadenectomy Does Not Improve Survival in Advanced Ovarian Cancer (5/5/2005)

Additional Surgery Does Not Improve Survival for Women with Advanced Ovarian Cancer (1/19/2005)

Women with Advanced Ovarian Cancer Survive Longer When Treated by a Gynecologic Oncologist (3/1/2002)

Reference: Winter W, Maxwell L, Tian C, et al. Tumor residual after surgical cytoreduction in prediction of clinical outcome in Stage IV epithelial ovarian cancer: a Gynecologic Oncology Group Study. Journal of Clinical Oncology [early online publication]. November 19, 2007. DOI: 10.1200/JCO.2007.13.1953.