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Secondary cytoreduction in ovarian cancer: who really benefits?

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Abstract

Purpose

To identify women affected by recurrent ovarian cancer who benefit from secondary cytoreductive surgery (SCS), analyse their clinical and biological features and investigate the role of minimally invasive surgery (MIS) and hyperthermic intraperitoneal-based chemotherapy (HIPEC) in this subset of patients.

Methods

This narrative review examines the data available from the updated literature. An electronic literature search was conducted in PubMed Medline databases for articles published from 1990 to 2018.

Results

Retrospective studies and preliminary data from the AGO-Desktop III trial show that cytoreductive surgery is associated with improved post-relapse survival in patients with platinum-sensitive relapse, compared to chemotherapy alone. This benefit is more evident in patients treated with complete or optimal primary debulking surgery at referral centres, who did not receive bevacizumab in first-line chemotherapy, and who present a localized pattern of disease. MIS has been proven to be a favourable approach to achieve a complete secondary debulking, reducing peri- and postoperative comorbidities. The application of HIPEC to SCS is associated with an improvement in oncological outcomes by preliminary results.

Conclusions

While waiting for the final results of the ongoing randomized controlled trials, SCS seems feasible and safe in selected patients with recurrent ovarian cancer. Recently, more attention has been focused on the biological features of ovarian tumours, such as BRCA status. Further studies and molecular research should be conducted to identify individualized and targeted therapies in the treatment of ovarian cancer recurrences.

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Author information

Authors and Affiliations

  1. Department of Woman and Child Health, IRCCS Fondazione Policlinico Agostino Gemelli, 00168, Rome, Italy

    Maria Teresa Giudice, Marco D’Indinosante, Serena Cappuccio, Valerio Gallotta, Anna Fagotti & Giovanni Scambia

  2. Gynecologic and Obstetric Clinic, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy

    Marco Petrillo

  3. School in Biomedical Sciences, University of Sassari, Sassari, Italy

    Marco Petrillo

Authors
  1. Maria Teresa Giudice
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  2. Marco D’Indinosante
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  3. Serena Cappuccio
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  4. Valerio Gallotta
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  5. Anna Fagotti
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  6. Giovanni Scambia
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  7. Marco Petrillo
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Contributions

MTG: Protocol/project development, Data collection, Manuscript writing and Manuscript editing. MD’I: Protocol/project development, Data collection, Manuscript writing and Manuscript editing. SC: Protocol/project development, Data collection. VG: Protocol/project development and Manuscript editing. AF: Protocol/project development and Manuscript editing. GS: Protocol/project development, Manuscript writing and Manuscript editing. MP: Protocol/project development, Data collection, Manuscript writing and Manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria Teresa Giudice.

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The authors declare that they have no conflicts of interest.

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Giudice, M.T., D’Indinosante, M., Cappuccio, S. et al. Secondary cytoreduction in ovarian cancer: who really benefits?. Arch Gynecol Obstet 298, 873–879 (2018). https://doi.org/10.1007/s00404-018-4915-1

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  • DOI: https://doi.org/10.1007/s00404-018-4915-1

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