Cytoreductive Surgery for a First Recurrence of Ovarian Cancer

People whose ovarian cancer recurs (returns) are usually treated with chemotherapy. Doctors and researchers have been looking for a better treatment for recurring ovarian cancer. They want to give people whose ovarian cancer comes back longer amounts of time before their cancer worsens and longer survival times.

New study finds benefit to surgery

Researchers in Germany wanted to see whether there was any benefit to cytoreductive surgery before chemotherapy for people whose ovarian cancer had come back for the first time. “Cytoreductive” just means the surgery is meant to remove as many cancer cells as possible. For their study, the researchers selected around 400 participants. Each of the participants had experienced a first recurrence of ovarian cancer at least 6 months after being treated with a platinum-based chemotherapy.^1,2

Participants were chosen based on the researchers’ belief that their cancer could be completely resected (removed) surgically. Doctors separated these participants into 2 groups:¹

1. 187 people received chemotherapy alone.
2. 192 had cytoreductive surgery to remove their cancer before they were treated with chemotherapy.

Of the participants, the people who received chemotherapy alone had a median survival of 3.8 years. The ones who had surgery followed by chemotherapy had a median survival of almost 4.5 years. About 75 percent of the people who had surgery were able to have a complete resection of their cancer. People whose cancer was completely removed had a median survival of just over 5 years.¹

It is important to remember that the median is the middle number in the range of survival times. It is not the same as the average time of survival. For example, if 5 people survived 1, 2, 5, 7, and 40 years, respectively, their median survival time would be 5 years. But their average survival time would be 11 years.

The study also found that there was no difference in the quality of life people in either group had after the treatment. This is good to know because it is not always worth changing treatments if the new option reduces your quality of life.¹

Comparison to past studies

This is not the first study that has looked at adding surgery to chemotherapy for people with recurrent ovarian cancer. Two other studies examined using surgery versus chemotherapy alone. One study showed that adding surgery could extend survival times. The other study showed that surgery did not help.¹

Doctors looked at why there was a difference in the results of these studies. They found that the most important difference between the studies was how participants were chosen.

Participants were chosen for the recent study and the study showed that surgery could extend survival because the researchers believed their surgery would be successful. These participants had to meet certain standards.

Participants had to have:^1-3

• Had their cancer completely resected before the first round of platinum-based chemotherapy
• A score showing that they were free of disability (able to do all the activities they could before their diagnosis without any restrictions)
• 500 mL or less of ascites (extra abdominal fluid)

Together, these standards make up what is called an AGO score, after a German gynecological oncology working group. People in the study that showed surgery did not help did not have to meet the same standards.¹

What does this mean for future treatment?

The recent study may encourage doctors to perform cytoreductive surgery on people with recurrent ovarian cancer before starting chemotherapy. Doctors will need to make sure that the benefit of surgery outweighs the risks.

People who can have their cancer completely removed with surgery seem to have the most success. It appears that surgery should be avoided if it cannot completely resect the cancer. In such cases, the surgery may cause more harm than good.

Talk to your doctor if you have any questions about cytoreductive surgery for a first-time recurrence of ovarian cancer. They can help you decide if you are a good candidate for surgery. Together you can decide what treatment is the best fit for your needs.