The Role of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Systematic Review and Meta-Analysis
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CONTINUING EDUCATION– GYNECOLOGIC ONCOLOGY
The Role of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Systematic Review and Meta-Analysis Claudia Marchetti, MD, PhD1, Anna Fagotti, MD, PhD1,2, Vincenzo Tombolini, FP3, Giovanni Scambia, FP, PhD1,2, and Francesca De Felice, MD, PhD3 1
Department of Woman and Child Sciences, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy; 3Department of Radiotherapy, Policlinico Umberto I, ‘‘Sapienza’’ University of Rome, Rome, Italy
2
ABSTRACT Background. Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. Methods. The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. Results. Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61–0.78; p \ 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48–0.66; p \ 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78–1.10; p = 0.37), but it was 0.73 (95% CI, 0.59–0.91) in favor of the complete resection subpopulation. Conclusion. This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
Ó Society of Surgical Oncology 2020 First Received: 23 June 2020 Accepted: 15 September 2020 F. De Felice, MD, PhD e-mail: [email protected]
Up to 80% of patients with ovarian cancer (OC) experience recurrence after definitive primary treatment, and their survival outcome remains poor (\ 15%)1. Based on the treatment-free interval after completion of prior chemotherapy, current international guidelines list secondary cytoreductive surgery as a treatment option for adequate management of platinum-sensitive patients with recurrent OC2. Nonetheless, its beneficial impact on survival outcomes compared with systemic therapy alone remains unclear and controversial, and only recently have data from a few randomized controlled trials been presented3–5. In this context, the current study aimed to present a systematic review of the literature comparing survival outcomes for recurrent OC between patients treated with secondary cytoreductive surgery followed by systemic therapy and patients managed with systemic therapy alone and to provide valuable evidence-based data for future research. METHODS Search Strategy and Selection Criteria The search strategy and selection processes w
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