abstract: Lymph node metastasis in stages I and II ovarian cancer: a review.

CONCLUSIONS:

The incidence of lymph node metastases in clinical early stage EOC is considerable. Based on the scarce literature data, omitting a systematic lymphadenectomy can only be considered in grade I mucinous tumors.

abstract: A randomized phase III trial of IV carboplatin and paclitaxel × 3 courses followed by observation versus weekly maintenance low-dose paclitaxel in patients with early-stage ovarian - GOG

Note: although a 3% difference of estimated recurrence rates (542 patients @ 3% = 16.26 patients/lives), the abstract does not allow for a description of the patient demographics eg. cell type, stage..., note also that as in past blogs the GOG studies include stage 1 and stage 11

OBJECTIVE:

To compare the recurrence-free interval (RFI) and safety profile in patients with completely resected high-risk early-stage ovarian cancer treated with intravenous (IV) carboplatin and paclitaxel with or without maintenance low-dose paclitaxel for 24weeks.

METHODS:

Eligibility was limited to patients with stage IA/B (grade 3 or clear cell), all IC or II epithelial ovarian cancer. All patients were to receive carboplatin AUC 6 and paclitaxel 175mg/m(2) q3 weeks×3 courses with random assignment to either observation or maintenance paclitaxel 40mg/m(2)/week×24weeks. Recurrence required clinical or radiological evidence of new tumor.

RESULTS:

There were 571 patients enrolled onto this study, of whom 29 were deemed ineligible due to inappropriate stage or pathology, leaving 542 patients. At least 3 cycles of treatment were administered to 524/542 (97%) of patients, and among those assigned to maintenance paclitaxel, 80% completed the regimen. The incidence of grade 2 or worse peripheral neuropathy (15.5% vs. 6%), infection/fever (19.9% vs. 8.7%), and dermatologic events (70.8% vs. 52.1%) was higher on the maintenance regimen (p<0.001). The cumulative probability of recurring within 5years for the maintenance paclitaxel regimen is 20% vs. 23% for surveillance (hazard ratio 0.807; 95% CI: 0.565-1.15). The probability of surviving 5years was 85.4% and 86.2%, respectively.

CONCLUSION:

Maintenance paclitaxel at 40mg/m(2)/week×24weeks added to standard dose AUC6 and paclitaxel 175mg/m(2)×3 doses provides no significant increase in RFI.

no abstract: Letter to the Editor - Surgical staging of early state epithelial ovarian cancer

 Note: requires subscription to view ($$)

 Letter to the Editor

Surgical staging of early stage epithelial ovarian cancer

Purchase

$ 39.95

David G. Huntsman^a, and C. Blake Gilks^{, a,}

^a Genetic Pathology Evaluation Centre of the Prostate Research Centre, Department of Pathology, Vancouver General Hospital and British Columbia Cancer Agency, Vancouver, BC, Canada

Received 15 March 2011; 

accepted 7 April 2011. 

Available online 30 April 2011.

Platinum-based adjuvant chemotherapy on moderate - and high-risk stage I and II epithelian ovarian cancer patients. Long-term single institution exper

Background Although the optimal management of women with FIGO stages I and II epithelial ovarian cancer (EOC) is still controversial, platinum-based adjuvant chemotherapy (CT) is the mainstay of treatment. Suboptimal survival results have led to major efforts to identify prognostic factors, improve surgical staging and develop adjuvant therapies to improve patients' outcomes.

Patients and methods We evaluate in a retrospective study clinical efficacy and the toxicity profile of a platinum-based adjuvant CT in FIGO stages I and II EOC treated at our institution from March 1984 to December 2006. Grade I FIGO stages IA-IB were excluded from the analysis. In the first period (1984-1997), patients received a platinum-based regimen without taxanes. In the second period from 1997 onwards, patients were treated with carboplatin and paclitaxel. Four to six cycles of adjuvant CT were administered. Potential predictive factors of efficacy and the role of paclitaxel addition were also analysed.

Results One hundred and fifty-eight patients (60 treated with paclitaxel) met inclusion criteria and were evaluable. Median age at diagnosis was 53.7 years (range 19-81) and most patients had an Eastern Cooperative Oncology Group performance status score (ECOG) of 0-1 (91.8%); 82.9% patients had pathological stage I and 17.1% pathological stage II. With a median follow up of 8.34 years (range 4.4-11.6), 103 patients (74.1%) were free of disease and 110 of them were alive (79.1%). Median relapse-free survival (RFS) and median overall survival (OS) had not been reached at the time of the analysis. No survival difference was found between paclitaxel and carboplatin combination or non-paclitaxel-containing regimens. Statistically significant prognostic factors for better RFS in the multivariate analysis were: ECOG 0 (p=0.023; HR 0.32; 95% CI 0.17-0.57); FIGO I stage (p<0.001; HR 0.30; 95% CI 0.15-0.58); I-II histological grade (p=0.005; HR 0.38; 95% CI 0.19-0.75); mucinous histology (p=0.013; HR 0.28; 95% CI 0.13-0.53); non-surgical adherences (p<0.002, HR 0.32; 95% CI 0.15-0.54); paracolic gutters inspection (p=0.033; HR 0.50; 95% CI 0.26-0.95) and liver surface biopsies (p=0.048; HR 0.64; 95% CI 0.41-0.98).Toxicity was generally mild and non-haematologic events were the most commonly found (62.9% of the total). The most frequent haematologic toxicities were neutropenia (41.7% in all grades, 9.5% grade 3-4) and anaemia (29.1% in all grades, 3.2% grade 3-4).

Conclusions The long-term outcome of this series is comparable to the published evidence and reflects the limited activity of platinum-based CT in the adjuvant setting. The potential survival advantage of the addition of paclitaxel to carboplatin cannot be definitively answered due to the small number of patients, the limited follow-up and the retrospective nature of the study. More effective and specific treatments are clearly required, in particular for those patients with stage II and undifferentiated tumours. Quality of surgery entails prognostic value.

Nearly 25% of Women With Early Ovarian Cancer Not Given Recommended Biopsies - US News and World Report

abstract: Surgical staging of early stage epithelial ovarian... [Gynecol Oncol. 2011] - PubMed result

Note: positive lymph node findings upgrade staging from early stage to advanced stage; full access is by subscription ($$$)


OBJECTIVES: The objectives of this study were to determine the adequacy of surgical staging performed on surgically treated epithelial ovarian cancer (EOC) patients with apparent early stage disease and to determine if receipt of surgical staging had an influence on survival.
METHODS: Detailed surgical staging information was collected from medical records for 721 patients diagnosed between 1998 and 2000 with EOC. Patients resided in California or New York and were identified through population-based cancer registries.
RESULTS:  Nearly 90% of patients had removal of the omentum and evaluation of bowel serosa and mesentery but only 72% had assessment of retroperitoneal lymph nodes and the majority of patients did not receive biopsies of other peritoneal locations. Only lymph node assessment (as well as node assessment combined with washings and omentectomy) had a statistically significant association with improved survival. The 5-year survival for women with node sampling was 84.2% versus 69.6% for those without this surgical procedure, and patients who did not have lymph node assessment had nearly twice the risk of death as those who did. When patients were stratified by receipt of chemotherapy, lack of node sampling had an effect only on patients who also had no chemotherapy (adjusted HR=2.2, CI=1.0-4.5).
CONCLUSIONS: The results of this population-based study confirm the prognostic importance of surgical staging for women with EOC, and the important role of gynecologic oncologists in treating these patients. Adjuvant chemotherapy does not appear to further improve survival for those women who receive adequate surgical staging.

abstract: Is surgical restaging indicated in apparent stage IA pure ovarian dysgerminoma?

Objective

Conservative surgery followed by platinum-based chemotherapy is considered the standard approach for pure ovarian dysgerminoma (POD), except for correctly staged IA patients. The aim of study was to evaluate the outcome of IA POD patients with incomplete surgical staging in order to define the proper management.

abstract: (Aug 6, 2010) Histotype predicts the curative potential of radiotherapy: the example of ovarian cancers

Blogger's Note: 

1) assumption - WAR (whole abdominal radiation - low dose/dosage; 2) ratio of cell types/RT; 3) study time period; 'apparent' stage 1/11; 4) surgical intervention by ?; 5) primary and/or secondary surgical debulking; 6) 'enhanced' as a %..... many questions in the absence of the full paper

 

Background: To explore the influence of ovarian cancer histotype on the effectiveness of adjuvant radiotherapy (RT).

Methods: A review of a population-based experience included all referred women with no reported macroscopic residuum following primary surgery who underwent adjuvant platin-based chemotherapy (CT), with or without sequential RT, and for whom it was possible to assign histotype according to the contemporary criteria.

Results: Seven hundred and three subjects were eligible, of these 351 received RT. For those with apparent stage I and II tumors, the cohort with clear cell (C), endometrioid (E), and mucinous (M) disease who additionally received RT exhibited a 40% reduction in disease-specific mortality and a 43% reduction in overall mortality.

Conclusions: The curability of those with stage I and II C-, E-, and M-type ovarian carcinomas was enhanced by RT-containing adjuvant therapy. This benefit did not extend to those with stage III or serous tumors. These findings necessitate reassessments of the role of RT and of the nonselective surgical and CT approaches that have characterized ovarian cancer care.

abstract: FDG-PET/CT in advanced ovarian cancer staging: Value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy

CONCLUSION:

Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions >5mm, but a high rate of false negative results in lesions <5mm such as in carcinomatosis. PET/CT should be used carefully in early stage disease, with low risk of peritoneal infiltration, because of high rate of false positive results, to avoid unnecessary therapy procedures.

Platinum-based adjuvant chemotherapy for early-stage ovarian cancer (abstract)

Conclusions
Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group.

Surgical Staging and Treatment of Early Ovarian Cancer: Long-term Analysis From a Randomized Trial -- Trimbos et al., 10.1093/jnci/djq149 -- JNCI Journal of the National Cancer Institute

"Abstract:
A long-term follow-up analysis of the randomized clinical trial Adjuvant Chemotherapy in Ovarian Neoplasm (ACTION) from the European Organization for Research and Treatment of Cancer was undertaken to determine whether the original results with a median follow-up of 5.5 years could be verified after longer follow-up with more events........Thus, completeness of surgical staging in patients with early ovarian cancer was found to be statistically significantly associated with better outcomes, and the benefit from adjuvant chemotherapy appeared to be restricted to patients with nonoptimal surgical staging."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Commentary:
CONTEXT AND CAVEATS

Prior knowledge

SGO: Change in Antigen Predicts Ovarian Cancer Outcomes - in Meeting Coverage early stage ovarian cancer

"The Gynecologic Oncology Group (GOG) 157 trial provided an opportunity to examine the change in CA-125 and its relationship to outcomes in women with early-stage ovarian cancer. The trial involved 427 women with stage I-II epithelial ovarian cancer. They were randomized to receive three or six cycles of chemotherapy with carboplatin and paclitaxel.
All patients had detailed surgical staging before randomization. Chan said detailed information about CA-125 levels was available for 350 participants in the trial."

"There is a lack of data in early-stage ovarian cancer on the pattern of CA-125," said Chan. "Previous studies generally had no comprehensive staging and no central pathology review."
"An elevated level that declined to normal after the first cycle of chemotherapy was associated with recurrence-free and overall survival of 87% and 88%, respectively.
Patients with an elevated CA-125 before and after the first cycle of chemotherapy had recurrence-free survival of 68% and overall survival of 77%."

abstract: Tumor Type and Substage Predict Survival in Stage I and II Ovarian Carcinoma: Insights and Implications

"Tumor grade has been the most accepted prognostic indicator of disease-specific survival among women with stage I and II ovarian carcinomas. Many investigators have included stage IB, grade 1 at diagnosis as low-risk disease and have suggested that women in this category should not receive adjuvant therapy. However, grading assignment appears to be unreliable because of problems with reproducibility and lack of consideration of biological differences between the different tumor types. Some investigators believe that classification based on tumor typing using new histopathological criteria was more reproducible than grade assignment and would more accurately reflect biological differences..."cont'd

uTube - Bradley J. Monk, MD, University of California Irvine talks about early stage ovarian cancer including clear cell SGO

Note: the title on this video is wrong

Doubling time of serum CA125 is an independent prognostic factor for survival in patients with (early stage) ovarian cancer relapsing after first-line chemotherapy

"There is a lack of data in early-stage ovarian cancer on the pattern of CA-125," said Chan. "Previous studies generally had no comprehensive staging and no central pathology review."
The Gynecologic Oncology Group (GOG) 157 trial provided an opportunity to examine the change in CA-125 and its relationship to outcomes in women with early-stage ovarian cancer. The trial involved 427 women with stage I-II epithelial ovarian cancer. They were randomized to receive three or six cycles of chemotherapy with carboplatin and paclitaxel.
All patients had detailed surgical staging before randomization. Chan said detailed information about CA-125 levels was available for 350 participants in the trial.

worth repeating: Understanding the problem of inadequately staging early ovarian cancer

Conclusions

Even in a randomised trial in which comprehensive surgical staging was strongly advised in the study protocol the majority of patients (66%) were incompletely staged. Factors relating to a lack of surgical skills attributed most to the number of incompletely staged patients, but insufficient knowledge of the tumour behaviour and routes of spread of ovarian cancer also contributed substantially to this problem. Multicentre trials recruiting patients from many institutes with small volume contribution to the study, run the risk of inadequate adherence to the study protocol.

Correspondence: Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management

Correspondence: Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategies

refers to original article (abstract):

Defining the surgical management of suspected early-stage ovarian cancer by estimating patient numbers through alternative management strategies