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  • APTSTAT3-9R br OBJECTIVE To examine the relationship between

    2019-10-21


    OBJECTIVE: To examine the relationship between volume and anatomic distribution of residual disease and oncologic outcomes among patients with advanced-stage epithelial ovarian/fallopian tube/primary peritoneal carcinoma undergoing neoadjuvant chemotherapy then interval debulking surgery. For patients who APTSTAT3-9R did not undergo a complete surgical resection, a surrogate for volume of residual disease was used to assess oncologic outcomes.
    STUDY DESIGN: Patient demographics, operative characteristics, anatomic site of residual disease, and outcome data were collected from medical records of patients with International Federation of Gy-necology and Obstetrics stage IIIC and IV epithelial ovarian cancer undergoing interval debulking surgery from January 2010 to July 2015. Among patients who did not undergo complete surgical 
    resection but had 1 cm of residual disease, the number of anatomic sites (single location vs multiple locations) with residual disease was used as a surrogate for volume of residual disease. The effect of residual disease volume on progression-free survival and overall survival was evaluated.
    CONCLUSION: Following interval debulking surgery, patients with complete surgical resection have the best prognosis, followed by patients with 1 cm single-anatomic location disease. In contrast, despite being considered “optimally debulked,” patients with 1 cm multiple-anatomic location disease have a survival similar to suboptimally debulked patients.
    Key words: epithelial ovarian cancer, interval debulking surgery, optimal cytoreduction
    E pithelial ovarian cancer (EOC) is diagnosed as stage III or stage IV disease in approximately two-thirds of cases, and patients typically present with high disease burden.1 Treatment re-quires intensive therapy, which tradi-tionally consists of initial debulking surgery followed by adjuvant platinum-based chemotherapy. Two prospective, randomized controlled trials have introduced an alternative to the standard approach of primary debulking surgery
    Cite Centrosomes article as: Manning-Geist BL, Hicks-Courant K, Gockley AA, et al. A novel classification of residual dis-ease after interval debulking surgery for advanced-stage ovarian cancer to better distinguish oncologic outcome. Am J Obstet Gynecol 2019
    (PDS) followed by chemotherapy, instead proposing neoadjuvant chemo-therapy (NACT) followed by interval debulking surgery (IDS) for patients with extensive and bulky abdominal disease at presentation.2,3 Relatively low rates of optimal cytoreduction and low median overall survival (OS) among PDS and NACT-IDS cohorts reported in these studies have generated concerns about the broader applicability of the findings. However, the observed non-inferior survival and decreased surgical morbidity in patients undergoing NACT-IDS compared with PDS have advanced NACT-IDS as an alternative treatment option for select patients.4,5 Specifically, patients with poor perfor-mance status and/or those who have a low likelihood of achieving optimal ( 1 cm) cytoreduction are thought to potentially benefit from NACT-IDS.6,7 
    Currently, surgical goals at the time of IDS have been extrapolated from well-established goals for PDS. Complete surgical resection (CSR) is particularly important at the time of IDS and affords the best prognosis. When CSR is unachievable, optimal residual disease is considered the next best alternative. Despite contradicting evidence on the survival benefit of IDS if macroscopic residual disease remains, the current definition of “optimal” after PDS is also applied to patients undergoing IDS.3,8e14 This definition of “optimal” only accounts for the size of the largest remaining tumor nodule and is defined as largest diameter of disease measuring 1.0 cm, independent of the total vol-ume of disease. Recent data reported by our group have revealed that patients classified as “optimal” after PDS display more heterogeneity in survival,