DEBULKING AND INTERVENTION SURGERY

Background: Cytoreductive surgery is generally regarded as integral to the management of patients with advanced ovarian cancer, although def initive conclusions about its role have been plagued by the lack of ra ndomized, prospective studies. With the availability of new informatio n, the current status of cytoreductive surgery for epithelial ovarian cancer is reviewed. Materials and methods: Available literature was re viewed, including some data currently published in abstract form only. Results: Several non-randomized studies of primary cytoreduction have shown that optimal cytoreduction (usually defined as residual nodules less than or equal to 1 cm diameter) can be achieved in the majority of cases, with acceptably low morbidity. Chemoresistant tumours will n ot benefit from cytoreduction, but these cannot be identified preopera tively. A recent EORTC randomized phase III trial examined the role of intervention cytoreduction after 3 cycles of chemotherapy for patient s with >1 cm residual disease following primarylaparotomy. Patients wi th chemoresistant tumours, who progressed on therapy, were excluded fr om the study, while the remaining patients were randomized between int ervention cytoreduction or 3 further cycles of chemotherapy. Seventy-f ive percent of patients were randomized. With follow-up data available on 278 patients, median progression-free interval and overall surviva l were prolonged by 5 and 6 months, respectively, in the surgical arm of the study (p = 0.01). The risk of progression and the overall risk of death were decreased by one third in patients in the surgical arm, and in the multivariate analysis, intervention surgery was an independ ent prognostic factor for progression-free and overall survival. Concl usions: The EORTC study of intervention cytoreduction is the first pha se III trial ever completed to evaluate the role of cytoreductive surg ery in advanced ovarian cancer. The conclusions clearly demonstrate th e importance of adequate surgery in the management of such patients.