Quaternary and beyond cytoreduction: An updated and expanded analysis Journal Article

   


Authors: Manning-Geist, B. L.; Chi, D. S.; Roche, K. L.; Zivanovic, O.; Sonoda, Y.; Gardner, G. J.; O'Cearbhaill, R. E.; Abu-Rustum, N. R.; Leitao, M. M. Jr
Article Title: Quaternary and beyond cytoreduction: An updated and expanded analysis
Abstract: Objective: We sought to describe the clinicopathologic features and outcomes of patients undergoing quaternary, quinary, or senary cytoreductive surgery for ovarian cancer. Methods: We retrospectively identified patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who underwent quaternary or beyond cytoreduction at our institution between 1/1/1989 and 12/31/2020. Kaplan-Meier curves were used to estimate survival and compared using the log-rank test. Coxproportional hazards regression was used to detect variables associated with survival. Results: Twenty patients underwent 24 quaternary (n = 20), quinary (n = 3), or senary (n = 1) cytoreductive surgeries. Most patients had high-grade (89.5%) and serous (75.0%) tumors. At the time of quaternary cytoreduction, 44.7% of patients had single-site disease and 85.0% achieved a complete gross resection. After quaternary cytoreduction, 34.8% of patients developed a surgical complication, most of which were grade 1 or 2. Postoperatively, 80.0% of patients received additional medical treatment and 20.0% underwent observation alone. On univariate analysis, factors associated with progression-free survival included prolonged treatmentfree interval (TFI), platinum sensitivity, and complete gross resection. Factors associated with disease-specific survival included platinum sensitivity and complete gross resection. Quinary and senary surgeries were associated with similar safety profiles, with no surgical complications reported. After quinary surgery, progression-free survival ranged from 5.0 to 216.0 months. Conclusions: In carefully selected patients, quaternary cytoreduction may be associated with acceptable morbidity and a relatively robust disease-specific survival. Patients who present to surgery with a prolonged TFI and achieve a complete gross resection likely derive the greatest benefit from quaternary surgery.
Keywords: cisplatin; chemotherapy; ovarian cancer; surgery; cytoreduction; trial; epithelial ovarian-cancer; recurrent; multicenter; stage-iii ovarian; quaternary cytoreduction; quinary; senary cytoreduction
Journal Title: Gynecologic Oncology Reports
Volume: 37
ISSN: 2352-5789
Publisher: Elsevier B.V.  
Date Published: 2021-08-01
Start Page: 100851
Language: English
ACCESSION: WOS:000698511800003
DOI: 10.1016/j.gore.2021.100851
PROVIDER: wos
PMCID: PMC8405887
PUBMED: 34485661
Notes: Article -- Source: Wos
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MSK Authors
  1. Ginger J Gardner
    273 Gardner
  2. Dennis S Chi
    712 Chi
  3. Yukio Sonoda
    475 Sonoda
  4. Mario Leitao
    579 Leitao
  5. Nadeem Abu-Rustum
    895 Abu-Rustum
  6. Oliver Zivanovic
    293 Zivanovic
  7. Roisin Eilish O'Cearbhaill
    273 O'Cearbhaill
  8. Kara Long Roche
    251 Long Roche
  9. Beryl Manning-Geist
    52 Manning-Geist
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