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Secondary Cytoreductive Surgery in Relapsed Platinum-Sensitive Epithelial Ovarian Cancer: A Systematic Review of Randomized Controlled Trials
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Faculty of Medicine, University of Bergen, 5009 Bergen, Norway
2
Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5009 Bergen, Norway
3
Department of Obstetrics and Gynecology, Haukeland University Hospital, 5009 Bergen, Norway
4
Department of Obstetrics and Gynecology, Stavanger University Hospital, 4068 Stavanger, Norway
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(14), 2613; https://doi.org/10.3390/cancers16142613 (registering DOI)
Submission received: 17 June 2024
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Revised: 14 July 2024
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Accepted: 19 July 2024
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Published: 22 July 2024
(This article belongs to the Special Issue Recent Advances in Ovarian Cancer Surgery)
Simple Summary
Secondary cytoreductive surgery is a treatment option for patients with relapsed platinum-sensitive epithelial ovarian cancer, yet the precise indications and criteria for patient selection remain to be outlined. Furthermore, the impact on progression-free and overall survival remains unclear. The objective of this systematic review was to determine the precise indications for secondary cytoreductive surgery and to elucidate the factors contributing to favorable outcomes associated with the intervention compared to conventional treatment modalities like standard-of-care chemotherapy. Our review confirmed that secondary cytoreductive surgery maintains morbidity, mortality, and quality of life standards for patients. While the trials included utilized different selection criteria for the procedure, our findings underscore the importance of careful patient selection to improve survival in conjunction with conventional chemotherapy.
Abstract
Secondary cytoreductive surgery is a treatment option for relapsed platinum-sensitive epithelial ovarian cancer, but no clear indications are defined for the procedure. This systematic review aims to establish clear indications and compare outcomes versus standard-of-care chemotherapy. We conducted an electronic literature search across three databases and identified 2033 articles, including three phase 3 randomized controlled trials (RCT). The review adhered to PRISMA 2020 guidelines and was registered in PROSPERO (no. CRD42022379817). Despite varying patient selection methods, surgery plus chemotherapy demonstrated significantly prolonged progression-free survival compared to chemotherapy alone. However, overall survival outcomes were inconsistent: while GOG-0213 did not show extended overall survival, recent studies with stricter defined criteria for surgery (SOC-1 and DESKTOP-III) reported improved overall survival with the addition of surgery. Morbidity and mortality rates were low, with no difference in quality of life between the surgery and no-surgery groups. In conclusion, cytoreductive surgery presents a promising option for recurrent epithelial ovarian cancer treatment. Nonetheless, well-defined selection criteria appear crucial for achieving increased overall survival compared to conventional treatment.
