Secondary surgical cytoreduction does not improve survival in recurrent ovarian cancer

Secondary surgical cytoreduction is feasible, with acceptable postoperative morbidity, but falls short of improving overall survival in patients with platinum-sensitive, recurrent ovarian cancer, according to study.

A total of 485 patients were randomized to undergo secondary surgical cytoreduction and then receive platinum-based chemotherapy (n=240) or to receive platinum-based chemotherapy alone (n=245). Decision on use of adjuvant chemotherapy (paclitaxel–carboplatin or gemcitabine–carboplatin) and bevacizumab was left to the investigators.

Over a median follow-up of 48.1 months, complete gross resection was achieved in 67 percent of the patients who underwent the procedure. Eighty-four percent of the population were given platinum-based chemotherapy with bevacizumab followed by bevacizumab maintenance, with the proportion similar in the two treatment groups.

Median overall survival was shorter in the surgery than in the no-surgery group (50.6 vs 64.7 months; hazard ratio [HR] for death, 1.29, 95 percent confidence interval [CI], 0.97–1.72; p=0.08). The estimate remained the same despite adjustment for platinum-free interval and chemotherapy choice.

Median progression-free survival was 18.9 months in the surgery group and 16.2 months in the no-surgery group (HR for disease progression or death, 0.82, 95 percent CI, 0.66–1.01). The 30-day surgical morbidity rate was 9 percent, and one patient (0.4 percent) died from postoperative complications.

Patient-reported quality of life was poor after surgery but did not differ than in the no-surgery group after recovery.