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abstract: ....An NRG Oncology/Gynecologic Oncology Group study
Highlights
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- 20% of suboptimal ovarian cancer patients had a pathologic CR at 2nd cytoreduction.
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- A pathologic CR at 2nd cytoreductive surgery is associated with improved PFS and OS.
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- A pathologic CR was not associated with known prognostic factors.
Abstract
Purpose
GOG
152 was a randomized trial of secondary cytoreductive surgery (SCS) in
patients with suboptimal residual disease (residual tumor nodule
> 1 cm in greatest diameter) following primary cytoreductive surgery
for advanced stage ovarian cancer. The current analysis was undertaken
to evaluate the impact of disease findings at SCS on progression-free
survival (PFS) and overall survival (OS).
Methods
Among
the 550 patients enrolled on GOG-152, two-hundred-sixteen patients were
randomly assigned following 3 cycles of cisplatin and paclitaxel to
receive SCS. In 15 patients (7%) surgery was declined or
contraindicated. In the remaining 201 patients the operative and
pathology reports were utilized to classify their disease status at the
beginning of SCS as; no gross disease/microscopically negative N = 40
(19.9%), no gross disease/microscopically positive N = 8 (4.0%), and
gross disease N = 153 (76.1%).
Results
The
median PFS for patients with no gross disease/microscopically negative
was 16.1 months, no gross disease/microscopically positive was
13.5 months and for gross disease was 11.7 months, P = 0.002.
The median OS for patients with no gross disease/microscopically
negative was 51.5 months, no gross disease/microscopically positive was
42.6 months and for gross disease was 34.9 months, P = 0.018.
Conclusion
Although
as previously reported SCS did not change PFS or OS, for those who
underwent the procedure, their operative and pathologic findings were
predictive of PFS and OS. Surgical/pathological residual disease is a
biomarker of response to chemotherapy and predictive of PFS and OS.
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