Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jun 16;2010(6):CD007822.
doi: 10.1002/14651858.CD007822.pub2.

Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer

Khadra Galaal  1 , Raj Naik, Robert E Bristow, Amit Patel, Andrew Bryant, Heather O Dickinson
Affiliations

Cytoreductive surgery plus chemotherapy versus chemotherapy alone for recurrent epithelial ovarian cancer

Khadra Galaal et al. Cochrane Database Syst Rev. .

Abstract

Background: Most women with advanced epithelial ovarian cancer will ultimately develop recurrent disease after completion of initial treatment with primary surgery and adjuvant chemotherapy. Secondary cytoreductive surgery may have survival benefits in selected patients. However, a number of chemotherapeutic agents are active in recurrent ovarian cancer and the standard treatment of patients with recurrent ovarian cancer remains poorly defined.

Objectives: To evaluate the effectiveness and safety of secondary surgical cytoreduction and chemotherapy compared to chemotherapy alone for women with recurrent epithelial ovarian cancer.

Search strategy: We searched the Cochrane Gynaecological Cancer Group Trials Register, The Cochrane Register of Controlled Trials, (CENTRAL) Issue 1 2009, MEDLINE and EMBASE up to February 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of review articles and contacted experts in the field.

Selection criteria: We searched for RCTs, quasi-randomised trials and non-randomised studies that compared secondary cytoreductive surgery and chemotherapy to chemotherapy alonein women with recurrent epithelial ovarian cancer.

Data collection and analysis: Three reviewers independently assessed whether potentially relevant studies met the inclusion criteria. No trials were found and therefore no data were analysed.

Main results: The search strategy identified 1431 unique references of which all were excluded on the basis of title and abstract.

Authors' conclusions: We found no evidence from RCTs to inform decisions about secondary surgical cytoreduction and chemotherapy compared to chemotherapy alone for women with recurrent epithelial ovarian cancer. Ideally, a large randomised controlled trial or, at the very least, well designed non-randomised studies that use multivariate analysis to adjust for baseline imbalances are needed to compare these treatment modalities.

PubMed Disclaimer

Conflict of interest statement

None

Update of

  • doi: 10.1002/14651858.CD007822

References

References to ongoing studies

AGO‐OVAR OP.4 {published and unpublished data}
    1. Harter P, Kurzeder C, du Bios A. A randomized multicenter study to compare the efficacy of additional tumor debulking surgery versus chemotherapy alone for recurrent platinum‐sensitive ovarian cancer. ClinicalTrials.gov Identifier: NCT01166737 2012.

Additional references

Boente 1998
    1. Boente MP, Chi DS, Hoskins WJ. The role of surgery in the management of ovarian cancer: primary and interval cytoreductive surgery. Seminars in Oncology 1998;25:326‐34. - PubMed
Bookman 1998
    1. Bookman MA, Malmström H, Bolis G, Gordon A, Lissoni A, Krebs JB, et al. Topotecan for the treatment of advanced epithelial ovarian cancer: an open‐label phase II study in patients treated after prior chemotherapy that contained cisplatin or carboplatin and paclitaxel. Journal of Clinical Oncology 1998;16(10):3345‐52. - PubMed
Bristow 2002
    1. Bristow RE, Tomacruz RS, Armstrong DK, Timble EL, Montz FJ. Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta‐analysis. Journal of Clinical Oncology 2002;20:1248‐59. - PubMed
Bristow 2009
    1. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta‐analysis. Gynecologic Oncology 2009;112(1):265‐74. - PubMed
Bucher 1997
    1. Bucker HC, Guyatt GH, Griffith LE, Walter SD. The Results of Direct and Indirect Treatment Comparisons in Meta‐Analysis of Randomized Controlled Trials. Journal of Clinical Epidemiology 1997;Vol. 50(No. 6):683‐91. - PubMed
Burke 1994
    1. Burke TW, Morris M. Secondary cytoreductive surgery for ovarian cancer . Obstetrics and Gynecology Clinics of North America 1994;21:167‐78. - PubMed
CTCAE 2006
    1. Common Terminology Criteria for Adverse Events v3.0 (CTCAE). (http://ctep.cancer.gov/forms/CTCAEv3.pdf) August 9th 2006.
Deeks 2001
    1. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta‐analysis. In: Egger M, Davey Smith G, Altman DG (eds) editor(s). Systematic Reviews in Health Care: Meta‐Analysis in Context. 2nd Edition. London: BMJ Publication Group, 2001.
Delgado 1988
    1. Delgado G, Oram DH, Petril ES. Stage III epithelial ovarian cancer: the role of maximal surgical reduction. Gynecologic Oncology 1984;18:293‐8. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7:177‐88. - PubMed
Eisenkop 2000
    1. Eisenkop SM, Friedman RL, Spirtos NM. The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma. Cancer 2000;88:144‐53. - PubMed
EUROCARE 2003
    1. Sant M, Aareleid T, Berrino F, Bielska Lasota M, Carli PM, Faivre J et al and the EUROCARE Working Group. EUROCARE‐3: survival of cancer patients diagnosed 1990‐94 ‐ results and commentary. Annals of Oncology 2003;14 (Supplement 5):v61‐v118. - PubMed
Ferrero 2009
    1. Ferrero A, Logrippo V, Fuso L, Perotto S, Daniele A, Zola P. Gemcitabine and vinorelbine combination in platinum‐sensitive recurrent ovarian cancer. Internnational Journal of Gynecologic Cancer 2009;19(9):1529‐34. - PubMed
Gadducci 2000
    1. Gadducci A, Lacconi P, Cosio S, Fanucchi A, Cristofani R, Riccardo Genazzani A. Complete salvage surgical cytoreduction improves further survival of patients with late recurrent ovarian cancer. Gynecologic Oncology 2000;79(3):344‐9. - PubMed
GLOBOCAN 2002
    1. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARCPress, Lyon 2004.
Goff 2000
    1. Goff BA, Mander L, Muntz HG. Ovarian carcinoma diagnosis. Cancer 2000;89(10):2068‐75. - PubMed
Gonzalez‐Martin 2003
    1. Gonzalez‐Martin AA, CIavo E, Bover I, Rubio J, Arcusa A, Casado A. Randomized phaseII study of carboplatin versus paclitaxel‐carboplatin in platinum sensitive recurrent advanced ovarian carcinoma with assessment of quality of life. Proceedings of the American Society of Clinical Oncology 2003;22:abs 1812.
Gungor 2005
    1. Gungor M, Ortac F, Arvas M, Kosebay D, Sonmezer M, Kose K. The role of secondary cytoreductive surgery for recurrent ovarian cancer. Gynecologic Oncology 2005;97(1):74‐9. - PubMed
Hacker 1983
    1. Hacker NF, Berek JS, Lagasse CD, Neiberg RK, Elashoff RM. Primarycytoreductive surgery for epithelial ovarian cancer. Obstetrics and Gynecology 1983;61:413‐20. - PubMed
Harter 2006
    1. Harter P, du Bois A, Hahmann M, Hasenburg A, Burges A, Loibl S, et al. Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO)DESKTOP OVAR Trial. Annals of Surgical Oncology 2006;13(12):1702–10. - PubMed
Harter 2010
    1. Harter P, Hilpert F, Mahner S, Heitz F, Pfisterer J, du Bois A. Systemic therapy in recurrent ovarian cancer: current treatment options and new drugs. Expert Reviews in Anticancer Therapy 2010;10(1):81‐8. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2008
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Hoskins 1994
    1. Hoskins WJ, McGuire WP, Brady MF, Homesley HD, Creasman WT, Berman M, et al. The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with sub optimal residual epithelial ovarian carcinoma. American Journal of Obstetrics and Gynecology 1994;70:974‐80. - PubMed
IARC 2002
    1. Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer Incidence in Five Continents, Volume VIII. In: Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB editor(s). IARC Scientific Publication No. 155. Lyon: IARC Scientific Publication, 2002.
Jemal 2008
    1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T. Cancer Statistics. CA: A Cancer Journal for Clinicians 2008;58:71‐96. - PubMed
Johnson 2008
    1. Johnson NP, Selman T, Zamora J, Khan KS. Gynaecologic surgery from uncertainty to science: evidence‐based surgery is no passing fad. Reproduction Advanced Access 2008. - PubMed
Markman 2004
    1. Markman M, Markman J, Webster K, Zanotti K, Kulp B, Peterson G, et al. Duration of response to second‐line, platinum‐based chemotherapy for ovarian cancer: implications for patient management and clinical trial design. Journal of Clinical Oncology 2004;22(15):3120‐5. - PubMed
Monk 2009
    1. Monk BJ, Coleman RL. Changing the paradigm in the treatment of platinum‐sensitive recurrent ovarian cancer: from platinum doublets to nonplatinum doublets and adding antiangiogenesis compounds. International Journal of Gynecological Cancer 2009;S2:S63‐7. - PubMed
Munkarah 2004
    1. Munkarah AR, Coleman RL. Critical evaluation of secondary cytoreduction in recurrent ovarian cancer. Gynecologic Oncology 2004;95(2):273‐280. - PubMed
Ozols 2005
    1. Ozols RF, Rubin SC, Thomas GM, Robboy SJ. Epithelial ovarian cancer. In: Hoskins WJ, Perez CA, Young RC, BarakatR, Markman M, Randall M editor(s). Principles and Practice of Gynecologic Oncology. 4th Edition. Philadelphia, PA: Lippincott‐Raven Publishers, 2005:895‐987.
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta‐analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. - PubMed
Parmar 2003
    1. Parmar MK, Ledermann JA, Colombo N, du Bios A, Delaloye JF, Kristensen GB. Paclitaxel plus platinum‐based chemotherapy versus conventional platinum‐based chemotherapy in women with relapsed ovarian cancer. the ICON4/AGO‐OVAR‐2‐2 trial. Lancet 2003;361:2099‐2106. - PubMed
Piver 1988
    1. Piver MS, Lele SB, Marchetti DL, Baker TR, Tsukaso Y, Emrich LJ. The impact of aggressive debulking surgery and cisplatin‐based chemotherapy on progression‐free survival in Stage III and IV ovarian carcinoma. Journal of Clinical Oncology 1988;6:983‐9. - PubMed
Santillan 2007
    1. Santillan A, Karam AK, Li AJ, Giuntoli R, Gardner GJ, Cass L, et al. Secondary cytoreductive surgery for isolated nodal recurrence in patients with epithelial ovarian cancer. Gynecologic Oncology 2007;104:686–90. - PubMed
Scarabelli 2001
    1. Scarabelli C, Gallo A, Carbone A. Secondary cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecologic Oncology 2001;83:504‐12. - PubMed
Scully 1998
    1. Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Atlas of tumor pathology. Vol. fascicle 23 3rd series, Washington: Armed Forces Institute of Pathology, 1998:1‐168.
Selinger 2009
    1. Selinger G, Muelier LP, Kegal T, Kantekhardt EJ, Grothey A, Gros R, et al. Phase 2 trial of docetaxel, gemcitabine and oxliplatin combination in platinum‐pretreated epithelial ovarian cancer. International Journal of Gynecological Cancer 2009;19(9):1529‐34. - PubMed
Shepherd 1989
    1. Shepherd JH. Revised FIGO staging for gynaecological cancer. British Journal of Obstetrics and Gynaecology 1989;96(8):889‐92. - PubMed
Smith 2005
    1. Smith LH, Morris CR, Yasmeen S. Ovarian cancer: can we make the clinical diagnosis earlier. Cancer 2005;104(7):1398‐407. - PubMed
Tay 2000
    1. Tay E‐H, Grant PT, Gebski V, Hacker NF. Secondary Cytoreductive Surgery for RecurrentEpithelial Ovarian Cancer. Obstetrics and Gynecology 2002;99:1008‐13. - PubMed
Tebes 2007
    1. Tebes SJ, Sayer RA, Palmer JM, Tebes CC, Martino MA, Hoffman MS. Cytoreductive surgery for patients with recurrent epithelial ovarian carcinoma. Gynecologic Oncology 2007;106(3):482‐87. - PubMed
Weber 2009
    1. Weber B, Lortholary A, Mayer F, Bourgeois H, Orfeuvre H, Combe M, et al. Pegylated liposomal doxorubicin and carboplatin in late‐relapsing ovarian cancer: a GINECO group phase II trial. Anticancer Research 2009 Oct;29(10):4195‐200. - PubMed
Wright 2006
    1. Wright JD, Hagemann A, Rader JS, Viviano D, Gibb RK, Norris L, et al. Bevacizumab combination therapy in recurrent, platinum‐refractory, epithelial ovarian carcinoma: A retrospective analysis. Cancer 2006;107(1):83‐9. - PubMed

Publication types

MeSH terms