SECONDARY SURGICAL CYTOREDUCTION FOR ADVANCED EPITHELIAL OVARIAN-CANCER - PATIENT SELECTION AND REVIEW OF THE LITERATURE

BACKGROUND. Standard therapy for advanced epithelial ovarian cancer no w includes primary cytoreductive surgery followed by combination chemo therapy. Optimal primary debulking is associated with improved clinica l response rates to primary chemotherapy as well as longer overall sur vival. The benefits of secondary cytoreductive surgery for persistent or recurrent ovarian cancer have not been as clearly established as th ose of primary surgery. METHODS. The English language literature was s earched, using a MEDLINE database, to identify all clinical investigat ions pertaining to secondary cytoreductive surgery for epithelial ovar ian cancer. Additional sources were found in reference lists from orig inal research and review articles. Particular emphasis was placed on t hose studies allowing secondary operations for ovarian cancer to be gr ouped into four clinical scenarios: (1) recurrent disease, (2) second- look laparotomy (SLL), (3) interval cytoreduction, and (4) progressive disease. RESULTS. Patients with recurrent disease, particularly after a prolonged disease free interval, may derive a significant survival benefit from optimal debulking. The available data also indicate that patients whose disease is in complete clinical remission, with macrosc opic disease detected at the time of SLL, benefit from cytoreduction t o microscopic disease residual. Cytoreduction that leaves SLL patients with a small amount of macroscopic disease may provide some survival benefit, but the degree of that benefit is unclear. Patients who under go suboptimal primary debulking and later demonstrate a favorable resp onse to induction chemotherapy may derive a modest survival advantage from an optimal interval cytoreductive procedure. CONCLUSIONS. Proper selection of patients with recurrent or initially suboptimally resecte d ovarian cancer is essential to maximize the potential therapeutic be nefit of secondary cytoreductive surgery. (C) 1996 American Cancer Soc iety.