paywalled: Clinical implications of pleural effusions in ovarian cancer - Porcel - Respirology - Wiley Online Library

 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.

open access: Upper abdominal cytoreduction and thoracoscopy for advanced epithelial ovarian cancer: unanswered questions and the impact on treatment - 75 patient study

	Positive thoracoscopy	Negative thoracoscopy
GOG, Gynecologic Oncology Group.
n (%)	27 (36.0)	48 (64.0)
Median (range) age, years	60.5 (29–75)	63 (39–76)
GOG Performance Status (0,1)	100%	100%
Location of largest disease
Diaphragm	2/27 (7.4%)	1/48 (2.1%)
Omentum	7/27 (25.9%)	10/48 (20.8%)
Pelvis	15/27 (55.6%)	37/48 (77.1%)
Lymph nodes	2/27 (7.4%)	1/48 (2.1%)
Mesentery	2/27 (7.4%)	1/48 (2.1%)

Table 2.  Surgical Procedures

Table 3.   Morbidity and mortality (Positive/Negative thoracoscopy - complications)

Conclusions

Epithelial ovarian cancer is most commonly diagnosed in advanced stages. The prognostic value of complete cytoreduction has been reported and confirmed in several publications.^6,21,22 Similarly intraperitoneal chemotherapy is associated with improved overall survival in women with small-volume residual disease (<1 cm) and, as with cytoreductive surgery, carries with it increased morbidity.

It is therefore mandatory to do all that is necessary to identify disease that cannot be resected before undertaking a maximal cytoreductive effort for disease that will not benefit from the use of intraperitoneal chemotherapy.

Using the surgical approach described allows both of these goals to be met, thereby maximising the potential benefit to women with advanced-stage epithelial ovarian cancer.