10 Minutes Talk

吳 華 席Hua-Hsi Wu, MD

OB/GYN, VGH-TPESep 08, 2008

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca

Introduction Epithelial ovarian carcinomas the majority of deaths fr

om gynecologic malignancies.

〜 70% newly diagnosed advanced disease

80% after OP+T/P complete clinical remission

75% of them recurrence

Platinum sensitive (PFI > 6M) combination C/T: Platinum/Taxol or Platinum/ Gemzar

Platinum-resistant Single agent C/T: Lipo-dox, topotecan, or Gemzar

The role of 2nd debulking in 1st relapsed Ov Ca

Clinical remission after 2nd line C/T

1. Unlike the high complete response rate after aggressive 1st-line C/T

2. Directly correlated with PFI

3. Shorter than previous one in 94% of cases

4. It may be possible to improve the chance of complete response and/or duration of second remission by adding 2nd cytoreductive (SCR) surgery to chemotheapy.

The role of 2nd debulking in 1st relapsed Ov Ca

2nd debulking

Many reports clear survival benefit Most retrospective Outcome PFI, volume of relapsed dise

ase, residual tumor (primary or secondary) Clinical optimal cytoreduction (COC)

associated with ascites, performance status, stages, number of cycle and type of salvage chemotherapy, and CA125 values.

The role of 2nd debulking in 1st relapsed Ov Ca

The aim of this study

To investigate the benefit of SCR

To define criteria for selecting patients most likely benefit from SCR

The role of 2nd debulking in 1st relapsed Ov Ca

Patients and Methods

A retrospective population-based study on recorded information from 789 patients treated at the Norwegian Radium hospital during 1985-2000 for their initial recurrence. In all, 217 had SCR and 572 were treated with chemotherapy alone.

The role of 2nd debulking in 1st relapsed Ov Ca

Results

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca

Copyright restrictions may apply.

Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591

Overall survival for patients with relapse of epithelial ovarian cancer for different treatment: no surgery, surgery for localized disease and surgery for disseminated disease (P < 0.01)

The role of 2nd debulking in 1st relapsed Ov Ca

Copyright restrictions may apply.

Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591

Overall survival for patients after surgery for relapse of epithelial ovarian cancer and radicalism of the secondary cytoreduction (P < 0.01)

The role of 2nd debulking in 1st relapsed Ov Ca

Copyright restrictions may apply.

Oksefjell, H. et al. Ann Oncol 2008 0:mdn591v1-591; doi:10.1093/annonc/mdn591

Overall survival for patients after surgery for relapse of epithelial ovarian cancer and treatment-free interval (TFI) (P < 0.01)

The role of 2nd debulking in 1st relapsed Ov Ca

Result

Complete optimal cytoreduction was achieved in 35% of all 217 patients

Residual disease after SCR, treatment-free interval (TFI) and age independent prognostic factors

Localised tumor was found to be the only significant factor to predict COC.

The role of 2nd debulking in 1st relapsed Ov Ca

Conclusion

1. SCR followed by C/T gives a clear survival benefit compared with C/T alone.

2. SCR should be offered when the tumor is localized.

3. The combination of COC, TFI > 24 months and age ≤ 39 years identifies a group of patients with the best OS.

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca

The role of 2nd debulking in 1st relapsed Ov Ca