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Top Line: While we’re just really getting into aggressive treatment of oligometastatic cancer, gyn oncs have been doing it for a while now with cytoreductive surgery.
The Study: The problem is that there are no randomized data to guide its use for ovarian cancer, especially in the setting of recurrence. Let’s think about this for a second. There’s tons of data that the extent of cytoreduction is associated with incremental improvements in survival. The problem is, there is tremendous selection bias when selecting a candidate to take to surgery, and even more so for which disease can be resected most. In GOG-0213, women with recurrent ovarian cancer were randomized to receive initial cytoreductive surgery and chemo or just chemo. They had to have been previously treated with platinum-based chemo followed by a disease-free interval of at least 6 months. 85% of all patients received platinum and bevacizumab (sigh) followed by maintenance bevacizumab (double sigh). Importantly, all were deemed good candidates for a complete resection, and two-thirds of the surgery arm achieved a complete gross resection. Sadly, cytoreductive surgery failed to improve overall survival (OS). In fact, median OS was 65 months without surgery and 50 months with surgery. That’s more than a year difference. And get this. An exploratory analysis showed that, among patients who had surgery, those who had a R0 resection outlived those who had R1-2 resection. Who did they not outlive? Those who didn’t even have surgery. Despite, of course, a significant improvement in PFS.
Bottom Line: Having 0 resection is better than having an R0 resection for recurrent ovarian cancer. | Coleman, N Engl J Med 2019