Blogger's Note: note the use of neoadjuvant therapy in this particular subset of ovarian cancer patients
Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology
Keywords:
- malignant pleural effusion;
- ovarian cancer;
- thoracoscopy;
- pleurodesis
ABSTRACT
The
pleural cavity constitutes the most frequent extra-abdominal metastatic
site in ovarian carcinoma (OC). In patients with OC and pleural
effusions, a positive fluid cytology is required for a stage IV
diagnosis. Unfortunately, about 30% of malignant pleural effusions
exhibit false negative cytological pleural fluid results. In those
circumstances, exploratory video-assisted thoracoscopic surgery (VATS)
serves as a diagnostic, staging and even therapeutic modality. Maximal
(no visible disease) or, at least, optimal (no residual implant greater
than 1 cm) cytoreduction should be the primary surgical goal in stage IV
OC patients. This is due to residual tumor after cytoreductive surgery
being one of the most important factors impacting on survival. Although
malignant pleural effusions do not preclude abdominal surgical
debulking, excision of gross pleural nodules may be necessary to achieve
optimal cytoreduction. VATS quantifies pleural tumor burden and allows
for intrathoracic cytoreduction or, if the latter is not feasible,
ensures that abdominal surgery is not unnecessarily performed on women
in whom gross tumor would still remain in the pleural space afterwards.
Taxane-platinum neoadjuvant chemotherapy should be offered to this
group. Patients with tumor extension into the pleural space have a
median overall survival of 2 years.
