980P - Cytoreductive surgery in recurrent ovarian cancer. The desktop series of the AGO study group, NOGGO, MITO, AGO-Austria, SGOG and GINECO

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Ovarian Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Jalid Sehouli
Authors J. Sehouli1, A. du Bois2, A. Zeimet3, A. Reuss4, G. Scambia5, R. Zang6, W. Meier7, S. Greggi8, F. Lécuru9, P. Harter2
  • 1Charite Medical University, 13353 - Berlin/DE
  • 2Dept Gynecology & Gyn.oncology, Kliniken Essen-Mitte, Essen/DE
  • 3Dept. Of Gynecology, Medizinische Universität, Innsbruck/AT
  • 4Coordinating Center For Clinical Trials, Philipps-University Marburg, Marburg/DE
  • 5Department Of Oncology, Catholic University of Sacred Heart, Campobasso/IT
  • 6Dept. Of Gynecologic Oncology, Fudan University Cancer Hospital, Shanghai/CN
  • 7Dept. Of Gynecology, Evangelisches Krankenhaus, Düsseldorf/DE
  • 8Gyecologic Oncology, Institutio Nazionale Tumori di Napoli, Naples/IT
  • 9Gynécologie Obstétrique, Hôpital Européen Georges Pompidou, Parise/FR

Abstract

Surgery in primary ovarian cancer for maximal cytoreduction is standard of care. However, the role of surgery in platinum sensitive recurrent ovarian cancer is less clear, especially regarding the following questions: (1) surgical aim, (2) identification of potential candidates for surgery, and (3) improvement of prognosis.

Material and methods

Retrospective multicentre study for identification of the surgical aim and hypothesis for a score to identify candidates for surgery (DESKTOP I trial). Subsequent prospective validation of the AGO score (DESKTOP II).

Results

The DESKTOP I trial analyzed 267 patients. Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [median 45.2 vs. 19.7 months; hazard ratio (HR) 3.71; 95% confidence interval (CI) 2.27-6.05; P < .0001]. A hypothetical score for prediction of complete cytoreduction was developed. This score was deemed positive, if three factors were present: (1) complete resection at 1st surgery (2) good performance status, and (3) absence of ascites. The prospective DESKTOP II trial screened 516 patients. 51% of the patients were classified as score positive and 129 patients with positive score and first recurrence underwent surgery. The rate of complete resection was 76% thus confirming the validity of this score regarding positive prediction of resectability in more than 2 out of 3 patients. Complication rate of secondary surgery was moderate with re-operations in 11% and peri-operative mortality in 0.8% of the patients.

Conclusions

Patients with recurrent ovarian cancer seem to have a benefit only from complete resection. The AGO score is a useful tool to identify patients in whom complete resection is feasible. The third step of the DESKTOP trials (DESKTOP III) comparing chemotherapy plus surgery versus chemotherapy alone in patients with platinum sensitive relapsed ovarian cancer is already recruiting patients.

Disclosure

All authors have declared no conflicts of interest.